title: Thromboprophylaxis and Incidence of Venous Thromboembolism in Patients With Hemophilia A or B Who Underwent High-Risk Orthopedic Surgeries.
abstract: Total hip replacement (THR) and total knee arthroplasty (TKA) carry a high risk of postoperative venous thromboembolism (VTE); therefore, anticoagulation prophylaxis is recommended in these patients. Unfortunately, there are no guidelines about VTE prophylaxis in patients with hemophilia who underwent these high-risk surgeries. To determine whether these patients have high risk of VTE, we conducted a retrospective study on patients with hemophilia who underwent elective THR/TKA at our institute from 2004 to 2012. Postoperatively, we collected information on duration and method of factor VIII/IX infusion, VTE-prophylaxis, and complications. There were 23 patients with hemophilia, 18 (78%) with hemophilia A and 5 (22%) with hemophilia B, who underwent high-risk surgeries (39% THR and 61% TKA). The VTE prophylaxis included sequential compression device, 12 (52%), and prophylactic enoxaparin, 1 (4%). Ten (43%) patients did not receive VTE prophylaxis. At 1-year follow-up, we did not find any evidence of clinical VTE in our patients. Better risk stratification is needed to identify patients who would benefit from pharmacological prophylaxis.
authors.affiliation: Division of Hematology & Oncology, Ellis Fischel Cancer Center, University of Missouri Health Care, Columbia, MO, USA razashahzad2@gmail.com.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Raza
authors.affiliation: Division of Hematology & Oncology, Ellis Fischel Cancer Center, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Gautam
authors.initials: G
authors.lastname: Kale
authors.affiliation: Division of Hematology & Oncology, Ellis Fischel Cancer Center, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kim
authors.affiliation: Division of Hematology & Oncology, Ellis Fischel Cancer Center, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Akbar
authors.affiliation: Division of Hematology & Oncology, Ellis Fischel Cancer Center, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Holm
authors.affiliation: Division of Hematology & Oncology, Ellis Fischel Cancer Center, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Ulad
authors.initials: U
authors.lastname: Naidzionak
authors.affiliation: Division of Hematology & Oncology, Ellis Fischel Cancer Center, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Akm M
authors.initials: AM
authors.lastname: Hossain
authors.affiliation: Division of Hematology & Oncology, Ellis Fischel Cancer Center, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Xiang
authors.initials: X
authors.lastname: Dong
authors.affiliation: Division of Hematology & Oncology, Ellis Fischel Cancer Center, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Donald C
authors.initials: DC
authors.lastname: Doll
authors.affiliation: Division of Hematology & Oncology, Ellis Fischel Cancer Center, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Carl E
authors.initials: CE
authors.lastname: Freter
authors.affiliation: Division of Hematology & Oncology, Ellis Fischel Cancer Center, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Hopkins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D058128:Compression Bandages; D017984:Enoxaparin / Q000008:administration & dosage*; D005164:Factor IX / Q000008:administration & dosage*; D005169:Factor VIII / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000601:surgery*; D002836:Hemophilia B / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D017984:Enoxaparin; C078147:F8 protein, human; D005169:Factor VIII; D005164:Factor IX
keywords: arthroplasty; hemophilia; hemophilia A; hemophilia B; hip; knee; orthopedic surgery; orthopedics; replacement; venous thromboembolism