title: A single-centre study of haemostatic outcomes of joint replacement in von Willebrand disease and control patients and an analysis of the literature.
abstract: BACKGROUND
  Haemostatic assessments of patients with von Willebrand disease (VWD) who undergo total knee arthroplasty (TKA) and total hip arthroplasty (THA) have mainly relied on subjective parameters.
  
  
  OBJECTIVE
  To compare objective haemostatic outcomes of TKA/THA in VWD patients and controls without bleeding disorders.
  
  
  METHODS
  We retrospectively analysed haemostatic outcomes in VWD patients undergoing TKA/THA from 1993 to 2011 and compared them with two matched controls per operation. Using one-way analysis of variance, we tested the effect of VWD on bleeding risk after TKA and THA.
  
  
  RESULTS
  Twelve VWD patients (6 type 1, 3 type 2M, 1 each of types 2A/2B/3) undergoing 19 operations (12 TKA, 7 THA) were matched to 38 controls. One (5%) of 19 operations in VWD patients and none of the control operations met clinical criteria for major bleeding. Baseline and postoperative day 1 haemoglobin levels, postoperative blood loss, transfused red blood cells (RBCs) and mean hospitalization days were not significantly different. More VWD patients than controls received RBC transfusions [12 (63%) vs. 12 (32%)]. Only 9 (47%) VWD patients vs. 38 (100%) controls received pharmacologic VTE prophylaxis. No postoperative symptomatic VTE occurred in either group.
  
  
  CONCLUSIONS
  In this largest, single-institutional study, von Willebrand factor replacement based on daily levels resulted in low frequency of major bleeding in VWD patients after TKA/THA. RBC transfusion was more frequent compared with matched controls, but other objective measures of haemostasis were similar. Lack of sufficient details in published reports precluded comparison of haemostatic outcomes.
authors.affiliation: Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: L
authors.initials: L
authors.lastname: Rugeri
authors.affiliation: Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Ashrani
authors.affiliation: Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: W L
authors.initials: WL
authors.lastname: Nichols
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Trousdale
authors.affiliation: Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: R K
authors.initials: RK
authors.lastname: Pruthi
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014842:von Willebrand Diseases / Q000188:drug therapy*
chemical_list: D006490:Hemostatics
keywords: arthroplasty, hip replacement; blood coagulation factors; blood transfusion; knee replacement; von Willebrand disease