Thromboprophylaxis and Incidence of Venous Thromboembolism in Patients With Hemophilia A or B Who Underwent High-Risk Orthopedic Surgeries

Raza, Shahzad; Kale, Gautam Kishore; Kim, Daniel; Akbar, Syed Ali; Holm, Lisa; Naidzionak, Ulad; Hossain, Akm Mosharraf; Doll, Donald C.; Freter, Carl E.; Hopkins, Tamara

doi:10.1177/1076029614543139

Cited by 15 publications

(19 citation statements)

References 28 publications

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“…The true incidence of symptomatic venous thromboembolism (VTE) in patients with hemophilia undergoing such surgeries is still uncertain. The estimated incidence in previous retrospective studies ranged from 0% to 1% 10 - 12 , whereas the incidence of symptomatic VTE was as high as 4.3% in 1 prospective multicenter study 13 . In our study, the incidence of VTE was comparable between the hemophilia and control cohorts for both hip (0% versus 0.64%) and knee (1.15% versus 0.98%) procedures.…”

Section: Discussionmentioning

confidence: 91%

In-Hospital Complications and Readmission in Patients with Hemophilia Undergoing Hip or Knee Arthroplasty

Chiasakul

Buckner²,

et al. 2020

JBJS Open Access

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Background: Individuals with hemophilia undergoing hip or knee arthroplasty are at risk for complications such as bleeding and infection. However, data on hospital length of stay (LOS) and readmission rates compared with nonhemophilic controls are lacking. This study compared the complication rates, LOS, and unplanned 30-day readmission rates between patients with hemophilia and nonhemophilic controls. Methods: This retrospective cohort study used the Pennsylvania Health Care Cost Containment Council (PHC4) database from 2007 to 2015 to compare outcomes in patients with hemophilia and nonhemophilic controls undergoing partial and total hip arthroplasty, knee arthroplasty, and revision knee arthroplasty. Results: A total of 118 patients with hemophilia and 3,811 controls were identified. Compared with controls, patients with hemophilia had a higher risk of bleeding complications after hip procedures (38.7% versus 16.1%, p = 0.003), a higher risk of surgical site infection after knee procedures (8.1% versus 1.1%, p < 0.001), longer median LOS after hip (6 versus 3 days, p < 0.001) and knee (5 versus 3 days, p < 0.001) procedures, and higher rates of unplanned 30-day readmission after hip (22.6% versus 4.1%, p < 0.001) and knee (10.3% versus 4.5%, p = 0.018) procedures. The most common reason for unplanned 30-day readmission in patients with hemophilia was bleeding or the patient’s underlying coagulopathy (25.1%). Conclusions: Patients with hemophilia undergoing hip or knee arthroplasty had a higher incidence of postoperative bleeding (hip procedures) and surgical site infections (knee procedures), longer LOS, and higher rates of unplanned 30-day readmission compared with nonhemophilic controls. Key limitations of our study include the potential for inaccurate coding, the relatively small number of patients in the hemophilia cohort, and the uneven distribution of procedure type in the hemophilia and control cohorts. Level of Evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 91%

In-Hospital Complications and Readmission in Patients with Hemophilia Undergoing Hip or Knee Arthroplasty

Chiasakul

Buckner²,

et al. 2020

JBJS Open Access

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“…694 Although routine pharmacological thromboprophylaxis is controversial in haemophiliac patients undergoing major orthopaedic surgery, half of the comprehensive haemophilia centres in Europe reported using pharmacological antithrombotic prophylaxis after major orthopaedic surgery, 508 in contrast to 37% of respondents to a US survey 695 and 4% in a retrospective analysis of one US centre. 696 However, one centre reported that 82% of haemophiliacs received perioperative VTE prophylaxis after the year 2000 with no evidence of increased bleeding complications. 517 Individualised antithrombotic therapy, based on local clinical experience, guidelines for non-haemophilia patients and the patient's clinical characteristics is recommended.…”

Section: Haemophilia a And B Recommendationsmentioning

confidence: 99%

Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

694

316

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: The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work.

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“…Therefore, all hemophilia centers will base their practices on the current state of knowledge and expert opinions until more valuable evidence is available. To the best of our knowledge, our series includes a larger number of hip/knee joint arthroplasties than the other reports 14,15 . The incidence of symptomatic VTE was 1 in 98 (1.02%) patients, which is lower than the incidence reported in the literature for patients without hemophilia undergoing the same surgical procedure in the absence of VTE prophylaxis 6 .…”

Section: Discussionmentioning

confidence: 85%

“…The average number of days of factor replacement was 16.78 (range, [14][15][16][17][18][19][20][21][22][23][24][25]. Serum mean FVIII level was 74.07%.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Incidence of Symptomatic Venous Thromboembolism in Patients with Hemophilia Undergoing Hip and Knee Joint Replacement without Chemoprophylaxis: A Retrospective Study

Peng

Wang

Zhai

et al. 2019

Orthopaedic Surgery

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Objective To establish the prevalence of clinically significant venous thromboembolic events (VTE) in hemophilia patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) without chemoprophylaxis and a modified coagulation factor substitution. Methods A cohort of patients who underwent THA and TKA from June 2002 to April 2017 were included. Based on World Federation of Hemophilia (WFH) guidelines, a modified coagulation factor substitution regimen was adopted. All patients were under a standardized postoperative protocol with routine mechanical prophylaxis against VTE. None of the patients received prophylactic anticoagulation. Only symptomatic patients were referred for radiological examination to exclude VTE. We evaluated the patient demographics and calculated the prevalence of VTE in our cohort. Results A total of 98 patients were reviewed. The patients were all men. Thirty‐one patients underwent primary THA with 39 hip arthroplasties (only 1 case with hemophilia B) and 67 patients underwent primary TKA with 101 knee arthroplasties (5 cases with hemophilia B). The mean age was 34.2 ± 7.8 years. The mean body mass index was 21.2 ± 5.7 kg/m2. There was 100% compliance to mechanical prophylaxis. The mean time to ambulation was 6.8 days (±2.5 days), and the mean hospital stay was 32.4 days (±7.1 days). There was only 1 hemophilia B patient with clinically significant VTE. None of the other 97 surgical cases had symptomatic VTE within 6 months after the procedure. This translates to a prevalence of 1.02%. Conclusion Given the low incidence (1.02%) of clinically significant VTE in our cohort, routine chemoprophylaxis in hemophilia patients undergoing THA and TKA may not be needed.

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Thromboprophylaxis and Incidence of Venous Thromboembolism in Patients With Hemophilia A or B Who Underwent High-Risk Orthopedic Surgeries

Cited by 15 publications

References 28 publications

In-Hospital Complications and Readmission in Patients with Hemophilia Undergoing Hip or Knee Arthroplasty

In-Hospital Complications and Readmission in Patients with Hemophilia Undergoing Hip or Knee Arthroplasty

Management of severe perioperative bleeding

Incidence of Symptomatic Venous Thromboembolism in Patients with Hemophilia Undergoing Hip and Knee Joint Replacement without Chemoprophylaxis: A Retrospective Study

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