Rates of Venous Thromboembolism and use of thromboprophylaxis after major orthopedic surgery in patients with congenital Hemophilia A or B: a systematic review.

Hemophilia Hemophiliac arthropathy Thromboprophilaxis Thrombosis Total joint replacement Venous Thromboembolism

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:
10 Jan 2024
Historique:
received: 23 10 2023
revised: 17 12 2023
accepted: 23 12 2023
medline: 13 1 2024
pubmed: 13 1 2024
entrez: 12 1 2024
Statut: aheadofprint

Résumé

Venous thromboembolism (VTE) is a well-recognized complication after total-joint replacement (TJR). Persons with hemophilia A or B are considered at low postoperative VTE risk due to their coagulation factor deficiencies and administering pharmacological thromboprophylaxis is often considered contraindicated. However, using factor replacement therapy could increase the postoperative VTE risk. To analyze best available evidences of VTE rates in persons with hemophilia A or B undergoing lower limb TJR and the use of postoperative pharmacological thromboprophylaxis. We systematically screened four online biomedical databases to identify studies reporting VTE rates in patients with hemophilia after TJR. Case reports and case series with less than ten patients were excluded. Twenty-six observational studies were included in this systematic review, reporting 1181 TJRs in patients with hemophilia A or B. Eight studies had VTE rates as the primary outcome. Five studies reported screen-detected VTE, while 21 papers reported symptomatic VTE events. Overall, 17 VTE events were reported (1.4%, 95% CI 0.9%-2.3%); 10 (6.6%) after 151 surgeries with postoperative VTE screening and 7 (0.7%) events in 1080 surgeries without postoperative screening. Thromboprophylaxis protocols were specified in 21 studies; postoperative thromboprophylaxis was used in 15 (1.3%) surgeries. This information was not available for 29.0% of the analyzed population. Despite the low thromboprophylaxis use in patients with hemophilia, rates of symptomatic VTE after TJR appeared to be low. We also highlighted the need to better report the thrombotic outcome in persons with hemophilia to face the ongoing changes in the hemophilia landscape.

Sections du résumé

BACKGROUND BACKGROUND
Venous thromboembolism (VTE) is a well-recognized complication after total-joint replacement (TJR). Persons with hemophilia A or B are considered at low postoperative VTE risk due to their coagulation factor deficiencies and administering pharmacological thromboprophylaxis is often considered contraindicated. However, using factor replacement therapy could increase the postoperative VTE risk.
OBJECTIVE OBJECTIVE
To analyze best available evidences of VTE rates in persons with hemophilia A or B undergoing lower limb TJR and the use of postoperative pharmacological thromboprophylaxis.
PATIENTS/METHODS METHODS
We systematically screened four online biomedical databases to identify studies reporting VTE rates in patients with hemophilia after TJR. Case reports and case series with less than ten patients were excluded.
RESULTS RESULTS
Twenty-six observational studies were included in this systematic review, reporting 1181 TJRs in patients with hemophilia A or B. Eight studies had VTE rates as the primary outcome. Five studies reported screen-detected VTE, while 21 papers reported symptomatic VTE events. Overall, 17 VTE events were reported (1.4%, 95% CI 0.9%-2.3%); 10 (6.6%) after 151 surgeries with postoperative VTE screening and 7 (0.7%) events in 1080 surgeries without postoperative screening. Thromboprophylaxis protocols were specified in 21 studies; postoperative thromboprophylaxis was used in 15 (1.3%) surgeries. This information was not available for 29.0% of the analyzed population.
CONCLUSIONS CONCLUSIONS
Despite the low thromboprophylaxis use in patients with hemophilia, rates of symptomatic VTE after TJR appeared to be low. We also highlighted the need to better report the thrombotic outcome in persons with hemophilia to face the ongoing changes in the hemophilia landscape.

Identifiants

DOI: 10.1016/j.jtha.2023.12.036 PMID: 38215910
pubmed: 38215910
pii: S1538-7836(24)00009-6
doi: 10.1016/j.jtha.2023.12.036
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.

Auteurs

Davide Santagata (D)

Department of Medicine and Surgery, Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese and Como, Italy.

Alessia Abenante (A)

Department of Medicine and Surgery, Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese and Como, Italy.

Alessandro Squizzato (A)

Department of Medicine and Surgery, Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese and Como, Italy.

Francesco Dentali (F)

Department of Medicine and Surgery, Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese and Como, Italy.

Marco Paolo Donadini (MP)

Department of Medicine and Surgery, Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese and Como, Italy.

Walter Ageno (W)

Department of Medicine and Surgery, Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese and Como, Italy.

Ingrid Pabinger (I)

Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.

Andreas Tiede (A)

Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.

Cihan Ay (C)

Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria. Electronic address: cihan.ay@meduniwien.ac.at.

Classifications MeSH