TY - JOUR
T1 - Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery
T2 - A prospective multicenter observational study
AU - Kleiboer, Brendan
AU - Layer, Marcus A.
AU - Cafuir, Lorraine A.
AU - Cuker, Adam
AU - Escobar, Miguel
AU - Eyster, M. Elaine
AU - Kraut, Eric
AU - Leavitt, Andrew D.
AU - Lentz, Steven R
AU - Quon, Doris
AU - Ragni, Margaret V.
AU - Thornhill, Dianne
AU - Wang, Michael
AU - Key, Nigel S.
AU - Buckner, Tyler W.
N1 - Publisher Copyright:
© 2022 International Society on Thrombosis and Haemostasis
PY - 2022/4
Y1 - 2022/4
N2 - Background: Persons with hemophilia (PWH) are at risk for chronic hemophilic arthropathy (HA). Joint replacement surgery may be used to relieve intractable pain and/or restore joint function. Objectives: This multicenter, prospective, observational cohort study evaluated the rate of bleeding during the postoperative period after total hip (THA) or knee arthroplasty (TKA). Patients/Methods: We included PWH of any severity ≥18 years of age who were undergoing THA or TKA. Clinical decisions were made at the discretion of the treating physician according to local standards of care. Clinical data were prospectively recorded. Major bleeding was defined as bleeding in a critical site, bleeding that resulted in either a 2 g/dl or greater decrease in hemoglobin during any 24-h period, or transfusion of two or more units of packed red blood cells. Results: One hundred thirty-one procedures (98 TKA and 33 THA) were performed, 39 (29.8%) of which were complicated by major bleeding, including 46% of THA and 25% of TKA. The risk of major bleeding was increased in THA compared to TKA (OR 2.50, p =.05), and by the presence of an inhibitor (OR 4.29, p =.04), increased BMI (OR 4.49 and 6.09 for overweight and obese, respectively, compared to normal BMI, each p <.01), and non-use of an antifibrinolytic medication (OR 3.00, p =.03). Neither continuous clotting factor infusion (versus bolus infusion) nor pharmacologic thromboprophylaxis were associated with bleeding risk. Conclusions: The bleeding risk remains substantial after THA and TKA in PWH, despite factor replacement. Use of antifibrinolytic medications is associated with decreased risk.
AB - Background: Persons with hemophilia (PWH) are at risk for chronic hemophilic arthropathy (HA). Joint replacement surgery may be used to relieve intractable pain and/or restore joint function. Objectives: This multicenter, prospective, observational cohort study evaluated the rate of bleeding during the postoperative period after total hip (THA) or knee arthroplasty (TKA). Patients/Methods: We included PWH of any severity ≥18 years of age who were undergoing THA or TKA. Clinical decisions were made at the discretion of the treating physician according to local standards of care. Clinical data were prospectively recorded. Major bleeding was defined as bleeding in a critical site, bleeding that resulted in either a 2 g/dl or greater decrease in hemoglobin during any 24-h period, or transfusion of two or more units of packed red blood cells. Results: One hundred thirty-one procedures (98 TKA and 33 THA) were performed, 39 (29.8%) of which were complicated by major bleeding, including 46% of THA and 25% of TKA. The risk of major bleeding was increased in THA compared to TKA (OR 2.50, p =.05), and by the presence of an inhibitor (OR 4.29, p =.04), increased BMI (OR 4.49 and 6.09 for overweight and obese, respectively, compared to normal BMI, each p <.01), and non-use of an antifibrinolytic medication (OR 3.00, p =.03). Neither continuous clotting factor infusion (versus bolus infusion) nor pharmacologic thromboprophylaxis were associated with bleeding risk. Conclusions: The bleeding risk remains substantial after THA and TKA in PWH, despite factor replacement. Use of antifibrinolytic medications is associated with decreased risk.
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U2 - 10.1111/jth.15654
DO - 10.1111/jth.15654
M3 - Article
C2 - 35080347
AN - SCOPUS:85124565374
SN - 1538-7933
VL - 20
SP - 857
EP - 865
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
IS - 4
ER -