Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: A prospective multicenter observational study.
Anticoagulants
/ therapeutic use
Antifibrinolytic Agents
Arthroplasty, Replacement, Hip
/ adverse effects
Hemophilia A
/ complications
Humans
Postoperative Complications
/ prevention & control
Postoperative Hemorrhage
/ prevention & control
Prospective Studies
Retrospective Studies
Venous Thromboembolism
/ prevention & control
antifibrinolytics
arthroplasty
hemophilia
hemorrhage
risk factors
Journal
Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
revised:
18
01
2022
received:
25
08
2021
accepted:
19
01
2022
pubmed:
27
1
2022
medline:
23
4
2022
entrez:
26
1
2022
Statut:
ppublish
Résumé
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. This multicenter, prospective, observational cohort study evaluated the rate of bleeding during the postoperative period after total hip (THA) or knee arthroplasty (TKA). 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. 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. The bleeding risk remains substantial after THA and TKA in PWH, despite factor replacement. Use of antifibrinolytic medications is associated with decreased risk.
Sections du résumé
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.
Identifiants
pubmed: 35080347
doi: 10.1111/jth.15654
pmc: PMC8940712
mid: NIHMS1775358
pii: S1538-7836(22)00145-3
doi:
Substances chimiques
Anticoagulants
0
Antifibrinolytic Agents
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
857-865Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL007149
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002489
Pays : United States
Informations de copyright
© 2022 International Society on Thrombosis and Haemostasis.
Références
J Bone Joint Surg Br. 2012 Nov;94(11 Suppl A):8-10
pubmed: 23118371
Vox Sang. 2013 Feb;104(2):135-43
pubmed: 23025325
J Bone Joint Surg Am. 2004 Jul;86(7):1512-8
pubmed: 15252101
Haemophilia. 2012 Nov;18(6):971-81
pubmed: 22776076
J Arthroplasty. 2016 Jul;31(7):1578-82
pubmed: 26869059
HSS J. 2020 Oct;16(3):218-221
pubmed: 33088236
J Am Acad Orthop Surg. 2011 Dec;19(12):768-76
pubmed: 22134209
Clin Orthop Relat Res. 1991 Aug;(269):98-101
pubmed: 1864063
Clin Appl Thromb Hemost. 2018 Nov;24(8):1315-1321
pubmed: 29716395
Basic Clin Pharmacol Toxicol. 2018 Jan;122(1):111-119
pubmed: 28691188
J Orthop. 2018 Jan 17;15(1):81-88
pubmed: 29657445
Semin Hematol. 2016 Jan;53(1):10-9
pubmed: 26805902
J Thromb Haemost. 2017 Nov;15(11):2115-2124
pubmed: 28836341
JB JS Open Access. 2020 Jun 5;5(2):e0085
pubmed: 33123670
Haemophilia. 2011 Mar;17(2):300-3
pubmed: 21070490
Haemophilia. 2020 Aug;26 Suppl 6:1-158
pubmed: 32744769
Blood. 2017 Apr 27;129(17):2368-2374
pubmed: 28183693
Chest. 2012 Feb;141(2 Suppl):e278S-e325S
pubmed: 22315265
Haemophilia. 2018 Sep;24(5):693-702
pubmed: 29944195
Thromb Haemost. 2016 Jul 4;116(1):42-9
pubmed: 27009484
J Bone Joint Surg Br. 2007 Feb;89(2):186-8
pubmed: 17322432
J Bone Joint Surg Am. 1999 Jan;81(1):2-10
pubmed: 9973048
J Am Acad Orthop Surg. 2004 Jul-Aug;12(4):234-45
pubmed: 15473675
Chest. 2012 Feb;141(2 Suppl):e185S-e194S
pubmed: 22315260
Clin Appl Thromb Hemost. 2018 Jul;24(5):815-821
pubmed: 28992766
J Thromb Haemost. 2010 Jan;8(1):202-4
pubmed: 19878532
J Thromb Haemost. 2010 Sep;8(9):1966-75
pubmed: 20586919
Expert Rev Hematol. 2019 May;12(5):325-333
pubmed: 30929534
Eur J Haematol. 2018 Apr;100 Suppl 1:14-24
pubmed: 29498783
J Arthroplasty. 2001 Apr;16(3):293-300
pubmed: 11307125
Blood Coagul Fibrinolysis. 2019 Sep;30(1S Suppl 1):S11-S13
pubmed: 31517710
J Bone Joint Surg Am. 2005 Jan;87(1):85-91
pubmed: 15634817
Health Qual Life Outcomes. 2018 May 2;16(1):84
pubmed: 29720192
Haemophilia. 2014 Sep;20(5):693-701
pubmed: 24612427
J Arthroplasty. 2019 Oct;34(10):2329-2336.e1
pubmed: 31337553