title: Incidence of symptomatic venous thromboembolism in patients with hemophilia undergoing joint replacement surgery: a retrospective study.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is a recognized complication after joint replacement surgery, and prophylaxis is routinely used in patients without bleeding disorders. However, for patients with hemophilia, pharmacologic prophylaxis is highly variable and controversial because of the inherent bleeding risk.
  
  
  OBJECTIVE
  To review our institutional experience with outcomes of total knee or hip arthroplasty with regard to symptomatic VTE and use of VTE prophylaxis in patients with hemophilia and without inhibitors.
  
  
  METHODS
  We reviewed records of 42 consecutive patients with hemophilia A or B who underwent 71 hip or knee replacements over a 39-year period. We also reviewed the literature to estimate the incidence of VTE after arthroplasty in the hemophilia population.
  
  
  RESULTS
  All patients used compression stockings for up to 6weeks after surgery; additionally, 6 cases (10.5%; 57 with available data) used sequential intermittent compression devices and 2 (2.8%) postoperatively received low-molecular-weight heparin. One patient (1.4%) who received low-molecular-weight heparin had a symptomatic, lower-extremity, deep venous thrombosis 10days after hip replacement for traumatic fracture. None of the other 70 surgical cases had symptomatic VTE within 3months after the procedure. Analysis of pooled data from published series of hemophilia patients undergoing arthroplasty showed an estimated incidence of symptomatic VTE of 0.5%.
  
  
  CONCLUSIONS
  Our study suggests that in patients with hemophilia, joint replacement surgery can be performed safely without routine pharmacologic VTE prophylaxis and without increasing risk of thromboembolic events. Pharmacologic VTE prophylaxis may be considered in select patients with known additional risk factors for VTE.
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: Juliana
authors.initials: J
authors.lastname: Perez Botero
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Spoon
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: Mrinal S
authors.initials: MS
authors.lastname: Patnaik
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: Aneel A
authors.initials: AA
authors.lastname: Ashrani
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Trousdale
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: pruthi.rajiv@mayo.edu.
authors.forename: Rajiv K
authors.initials: RK
authors.lastname: Pruthi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement; D006467:Hemophilia A / Q000150:complications* / Q000601:surgery; D002836:Hemophilia B / Q000150:complications* / Q000601:surgery; D006615:Hip / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007717:Knee / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000453:epidemiology*; D055815:Young Adult
keywords: Blood coagulation disorders; Blood coagulation factors; Embolism; Thrombosis