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DOI: 10.1160/TH15-10-0802
Prospective, multicenter study of postoperative deep-vein thrombosis in patients with haemophilia undergoing major orthopaedic surgery
Financial support: CSL Behring Foundation for Research and Advancement of Patient Health (Aug. 2008-Sept. 2011); Baxter BioScience Grant H11–000651 (Oct. 2011-completion of study); North Carolina Translational and Clinical Sciences Institute: Clinical and Translational Science Award program of the Division of Research Resources, National Institutes of Health (1UL1TR001111).
Publikationsverlauf
Received:
15. Oktober 2015
Accepted after major revision:
15. März 2016
Publikationsdatum:
27. November 2017 (online)
Summary
Perioperative clotting factor replacement is administered to reverse the inherent haemostatic defect in persons with haemophilia (PWH), potentially increasing their risk for developing venous thromboembolism (VTE) postoperatively. It was our objective to determine the prevalence of VTE in PWH undergoing total hip or knee arthroplasty (THA, TKA). Patients with haemophilia A or B who underwent THA or TKA were enrolled in this prospective, multicentre observational cohort study. Lower extremity venous duplex ultrasound was performed prior to surgery and 4–6 weeks after surgery. Eleven centres enrolled 51 subjects, 46 of whom completed the study. Six subjects (13.0 %) were treated with bypass agents perioperatively; the remaining 40 subjects received factor VIII or IX replacement. Intermittent pneumatic compression devices were utilised postoperatively in 23 subjects (50 %), and four subjects (8.7 %) also received low-molecular-weight heparin prophylaxis. One subject (2.2 %) with moderate haemophilia A was diagnosed with symptomatic distal deep-vein thrombosis (DVT) on day 6 following TKA. One subject (2.2 %) with severe haemophilia A was diagnosed with pulmonary embolism on day 9 following bilateral TKA. No subjects had asymptomatic DVT. Eighteen subjects (39.1 %) had major bleeding, and three subjects (6.5 %) experienced minor bleeding. The observed prevalence of ultrasound-detectable, asymptomatic DVT in PWH following TKA or THA in this study was low, but the incidence of symptomatic VTE (4.3 %, 95 % CI, 0.5–14.8 %) appeared similar to the estimated incidence in the general population without thromboprophylaxis.
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References
- 1 Falck-Ytter Y, Francis CW, Johanson NA. et al. Prevention of VTE in orthopaedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e278S-325S.
- 2 Siboni SM, Biguzzi E, Pasta G. et al. Management of orthopaedic surgery in rare bleeding disorders. Haemophilia 2014; 20: 693-701.
- 3 Srivastava A, Brewer AK, Mauser-Bunschoten EP. et al. Guidelines for the management of hemophilia. Haemophilia 2013; 19: e1-47.
- 4 Pradhan SM, Key NS, Boggio L. et al. Venous thrombosis prophylaxis in haemophilics undergoing major orthopaedic surgery: a survey of haemophilia treatment centres. Haemophilia 2009; 15: 1337-1338.
- 5 Zakarija A, Aledort L. How we treat: venous thromboembolism prevention in haemophilia patients undergoing major orthopaedic surgery. Haemophilia 2009; 15: 1308-1310.
- 6 Mont MA, Jacobs JJ, Boggio LN. et al. Preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Am Acad Orthop Surg 2011; 19: 768-776.
- 7 Turpie AG, Levine MN, Hirsh J. et al. A randomized controlled trial of a lowmolecular-weight heparin (enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery. N Engl J Med 1986; 315: 925-929.
- 8 Torholm C, Broeng L, Jorgensen PS, Bjerregaard P, Josephsen L, Jorgensen PK. et al. Thromboprophylaxis by low-molecular-weight heparin in elective hip surgery. A placebo controlled study. J Bone Joint Surg Br 1991; 73: 434-438.
- 9 Leclerc JR, Geerts WH, Desjardins L. et al. Prevention of deep vein thrombosis after major knee surgery--a randomized, double-blind trial comparing a low molecular weight heparin fragment (enoxaparin) to placebo. Thromb Haemost 1992; 67: 417-423.
- 10 Bergqvist D, Benoni G, Bjorgell O. et al. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med 1996; 335: 696-700.
- 11 Fuji T, Ochi T, Niwa S. et al. Prevention of postoperative venous thromboembolism in Japanese patients undergoing total hip or knee arthroplasty: two randomized, double-blind, placebo-controlled studies with three dosage regimens of enoxaparin. J Orthop Sci 2008; 13: 442-451.
- 12 Eriksson BI, Borris LC, Friedman RJ. et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008; 358: 2765-2775.
- 13 Lassen MR, Ageno W, Borris LC. et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med 2008; 358: 2776-2786.
- 14 Eriksson BI, Dahl OE, Huo MH. et al. Oral dabigatran versus enoxaparin for thromboprophylaxis after primary total hip arthroplasty (RE-NOVATE II*). A randomised, double-blind, non-inferiority trial. Thromb Haemost 2011; 105: 721-729.
- 15 Eriksson BI, Dahl OE, Rosencher N. et al. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost 2007; 05: 2178-2185.
- 16 McKenna R, Galante J, Bachmann F. et al. Prevention of venous thromboembolism after total knee replacement by high-dose aspirin or intermittent calf and thigh compression. Br Med J 1980; 280: 514-517.
- 17 Hull RD, Raskob GE, Gent M. et al. Effectiveness of intermittent pneumatic leg compression for preventing deep vein thrombosis after total hip replacement. J Am Med Assoc 1990; 263: 2313-2317.
- 18 Urbankova J, Quiroz R, Kucher N. et al. Intermittent pneumatic compression and deep vein thrombosis prevention. A meta-analysis in postoperative patients. Thromb Haemost 2005; 94: 1181-1185.
- 19 Chin PL, Amin MS, Yang KY. et al. Thromboembolic prophylaxis for total knee arthroplasty in Asian patients: a randomised controlled trial. J Orthop Surg 2009; 17: 1-5.
- 20 Geerts WH, Bergqvist D, Pineo GF. et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. (8th Edition). Chest 2008; 133: 381S-453S.
- 21 Perez Botero J, Spoon DB, Patnaik MS. et al. Incidence of symptomatic venous thromboembolism in patients with hemophilia undergoing joint replacement surgery: a retrospective study. Thromb Res 2015; 135: 109-113.
- 22 Lensing AW, Doris CI, McGrath FP. et al. A comparison of compression ultrasound with color Doppler ultrasound for the diagnosis of symptomless postoperative deep vein thrombosis. Arch Intern Med 1997; 157: 765-768.
- 23 Schellong SM, Beyer J, Kakkar AK. et al. Ultrasound screening for asymptomatic deep vein thrombosis after major orthopaedic surgery: the VENUS study. J Thromb Haemost 2007; 05: 1431-1437.
- 24 Hermans C, Hammer F, Lobet S. et al. Subclinical deep venous thrombosis observed in 10 % of hemophilic patients undergoing major orthopaedic surgery. J Thromb Haemost 2010; 08: 1138-1140.
- 25 Takedani H, Ohnuma K, Hirose J. Deep venous thrombosis was not detected after total knee arthroplasty in Japanese patients with haemophilia. Haemophilia. 2015 Epub ahead of print.
- 26 Chevalier Y, Dargaud Y, Lienhart A. et al. Seventy-two total knee arthroplasties performed in patients with haemophilia using continuous infusion. Vox Sang 2013; 104: 135-143.
- 27 Dahl OE, Quinlan DJ, Bergqvist D. et al. A critical appraisal of bleeding events reported in venous thromboembolism prevention trials of patients undergoing hip and knee arthroplasty. J Thromb Haemost 2010; 08: 1966-1975.