Journal article
Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: A prospective multicenter observational study
Journal of thrombosis and haemostasis, Vol.20(4), pp.857-865
04/2022
DOI: 10.1111/jth.15654
PMCID: PMC8940712
PMID: 35080347
Abstract
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.
Details
- Title: Subtitle
- Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: A prospective multicenter observational study
- Creators
- Brendan Kleiboer - Department of Medicine and UNC Blood Research Center University of North CarolinaMarcus A. Layer - Department of Medicine and UNC Blood Research Center University of North CarolinaLorraine A. Cafuir - Emory UniversityAdam Cuker - University of PennsylvaniaMiguel Escobar - The University of Texas Health Science CenterM. Elaine Eyster - Penn State Milton S. Hershey Medical CenterEric Kraut - The Ohio State UniversityAndrew D. Leavitt - University of California, San FranciscoSteven R. Lentz - University of Iowa Carver College of MedicineDoris Quon - Orthopaedic Institute for ChildrenMargaret V. Ragni - University of Pittsburgh School of MedicineDianne Thornhill - University of Colorado DenverMichael Wang - University of Colorado DenverNigel S. Key - Department of Medicine and UNC Blood Research Center University of North CarolinaTyler W. Buckner - University of Colorado Denver
- Resource Type
- Journal article
- Publication Details
- Journal of thrombosis and haemostasis, Vol.20(4), pp.857-865
- DOI
- 10.1111/jth.15654
- PMID
- 35080347
- PMCID
- PMC8940712
- ISSN
- 1538-7933
- eISSN
- 1538-7836
- Number of pages
- 9
- Grant note
- National Center for Advancing Translational Sciences (UL1TR002489) National Heart, Lung, and Blood Institute (T32 HL007149) Baxter Healthcare Corporation / Shire
- Language
- English
- Date published
- 04/2022
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984359929102771
Metrics
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