Thromboprophylaxis and Outcomes for Total Joint Arthroplasty in Congenital Bleeding Disorders: A Single-Center Experience.
Total joint arthroplasty (TJA) improves the quality of life for patients with end-stage osteoarthritis but is associated with an increased risk of venous thromboembolism (VTE), thus pharmacologic thromboprophylaxis is recommended for most patients. Patients with congenital bleeding disorders may develop severe arthropathies due to repeated hemarthroses and derive similar benefit from TJA as the general population. No guidelines for pharmacologic thromboprophylaxis in this population exist, however, as the risks and benefits are not well defined. We undertook the current study to assess the safety and efficacy of pharmacologic VTE prophylaxis in patients with congenital bleeding disorders undergoing TJA. We retrospectively reviewed the medical records of patients with bleeding disorders who underwent TJA at our academic institution between 1987 and 2012. We identified 28 patients who underwent 38 TJA procedures. Low-molecular-weight heparin (LMWH) was administered in 29 procedures (76%) and was discontinued early in 3 procedures (2 patients) due to nonjoint bleeding. No symptomatic VTE was identified, and no joint or deep wound infections were seen. Twenty-two patients accounting for 31 procedures were contacted to discuss their experience with TJA. All reported decreased pain, and 97% reported improved function after the surgery. Impressively, 97% stated that they would choose to have the surgery again. These results confirm the benefit of TJA in patients with congenital bleeding disorders and end-stage arthropathies and suggest that LMWH thromboprophylaxis is safe. No patient in our cohort developed symptomatic VTE, whether or not thromboprophylaxis was administered, thus necessity of thromboprophylaxis remains an unanswered question.
Hemophilia & Thrombosis Center, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.
Britt M
BM
Holderness
Hemophilia & Thrombosis Center, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.
Yuika
Y
Goto
Hemophilia & Thrombosis Center, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.
Laurel
L
McKernan
Hemophilia & Thrombosis Center, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.
Philip
P
Bernini
Hemophilia & Thrombosis Center, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA dlornstein@hitchcock.org.
Deborah L
DL
Ornstein
D000293:Adolescent; D000328:Adult; D000368:Aged; D001178:Arthroplasty; D001778:Blood Coagulation Disorders / Q000151:congenital / Q000628:therapy*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000517:prevention & control* / Q000628:therapy; D055815:Young Adult
D006495:Heparin, Low-Molecular-Weight
hemophilia; low-molecular-weight heparin; thromboprophylaxis; total joint arthroplasty