Prospective, multicenter study of postoperative deep-vein thrombosis in patients with haemophilia undergoing major orthopaedic surgery

Tyler W. Buckner, Andrew D. Leavitt, Margaret Ragni, Christine L. Kempton, M. Elaine Eyster, Adam Cuker, Steven R. Lentz, Jonathan Ducore, Cindy Leissinger, Mike Wang, Nigel S. Key

Research output: Contribution to journalArticle

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Abstract

Perioperative clotting factor replacement is administered to reverse the inherent haemostatic defect in persons with haemophilia (PWH), potentially increasing their risk for developing venous thromboembolism (VTE) postoperatively. It was our objective to determine the prevalence of VTE in PWH undergoing total hip or knee arthroplasty (THA, TKA). Patients with haemophilia A or B who underwent THA or TKA were enrolled in this prospective, multicentre observational cohort study. Lower extremity venous duplex ultrasound was performed prior to surgery and 4-6 weeks after surgery. Eleven centres enrolled 51 subjects, 46 of whom completed the study. Six subjects (13.0 %) were treated with bypass agents perioperatively; the remaining 40 subjects received factor VIII or IX replacement. Intermittent pneumatic compression devices were utilised postoperatively in 23 subjects (50 %), and four subjects (8.7 %) also received low-molecular-weight heparin prophylaxis. One subject (2.2 %) with moderate haemophilia A was diagnosed with symptomatic distal deep-vein thrombosis (DVT) on day 6 following TKA. One subject (2.2 %) with severe haemophilia A was diagnosed with pulmonary embolism on day 9 following bilateral TKA. No subjects had asymptomatic DVT. Eighteen subjects (39.1 %) had major bleeding, and three subjects (6.5 %) experienced minor bleeding. The observed prevalence of ultrasound-detectable, asymptomatic DVT in PWH following TKA or THA in this study was low, but the incidence of symptomatic VTE (4.3 %, 95 % CI, 0.5-14.8 %) appeared similar to the estimated incidence in the general population without thromboprophylaxis.

Original languageEnglish (US)
Pages (from-to)42-49
Number of pages8
JournalThrombosis and Haemostasis
Volume116
Issue number1
DOIs
StatePublished - Jul 1 2016

Fingerprint

Hemophilia A
Venous Thrombosis
Multicenter Studies
Orthopedics
Prospective Studies
Tacrine
Venous Thromboembolism
Intermittent Pneumatic Compression Devices
Hemorrhage
Hemophilia B
Knee Replacement Arthroplasties
Factor IX
Blood Coagulation Factors
Low Molecular Weight Heparin
Incidence
Factor VIII
Hemostatics
Pulmonary Embolism
Observational Studies
Hip

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Buckner, Tyler W. ; Leavitt, Andrew D. ; Ragni, Margaret ; Kempton, Christine L. ; Elaine Eyster, M. ; Cuker, Adam ; Lentz, Steven R. ; Ducore, Jonathan ; Leissinger, Cindy ; Wang, Mike ; Key, Nigel S. / Prospective, multicenter study of postoperative deep-vein thrombosis in patients with haemophilia undergoing major orthopaedic surgery. In: Thrombosis and Haemostasis. 2016 ; Vol. 116, No. 1. pp. 42-49.
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abstract = "Perioperative clotting factor replacement is administered to reverse the inherent haemostatic defect in persons with haemophilia (PWH), potentially increasing their risk for developing venous thromboembolism (VTE) postoperatively. It was our objective to determine the prevalence of VTE in PWH undergoing total hip or knee arthroplasty (THA, TKA). Patients with haemophilia A or B who underwent THA or TKA were enrolled in this prospective, multicentre observational cohort study. Lower extremity venous duplex ultrasound was performed prior to surgery and 4-6 weeks after surgery. Eleven centres enrolled 51 subjects, 46 of whom completed the study. Six subjects (13.0 {\%}) were treated with bypass agents perioperatively; the remaining 40 subjects received factor VIII or IX replacement. Intermittent pneumatic compression devices were utilised postoperatively in 23 subjects (50 {\%}), and four subjects (8.7 {\%}) also received low-molecular-weight heparin prophylaxis. One subject (2.2 {\%}) with moderate haemophilia A was diagnosed with symptomatic distal deep-vein thrombosis (DVT) on day 6 following TKA. One subject (2.2 {\%}) with severe haemophilia A was diagnosed with pulmonary embolism on day 9 following bilateral TKA. No subjects had asymptomatic DVT. Eighteen subjects (39.1 {\%}) had major bleeding, and three subjects (6.5 {\%}) experienced minor bleeding. The observed prevalence of ultrasound-detectable, asymptomatic DVT in PWH following TKA or THA in this study was low, but the incidence of symptomatic VTE (4.3 {\%}, 95 {\%} CI, 0.5-14.8 {\%}) appeared similar to the estimated incidence in the general population without thromboprophylaxis.",
author = "Buckner, {Tyler W.} and Leavitt, {Andrew D.} and Margaret Ragni and Kempton, {Christine L.} and {Elaine Eyster}, M. and Adam Cuker and Lentz, {Steven R.} and Jonathan Ducore and Cindy Leissinger and Mike Wang and Key, {Nigel S.}",
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Buckner, TW, Leavitt, AD, Ragni, M, Kempton, CL, Elaine Eyster, M, Cuker, A, Lentz, SR, Ducore, J, Leissinger, C, Wang, M & Key, NS 2016, 'Prospective, multicenter study of postoperative deep-vein thrombosis in patients with haemophilia undergoing major orthopaedic surgery', Thrombosis and Haemostasis, vol. 116, no. 1, pp. 42-49. https://doi.org/10.1160/TH15-10-0802

Prospective, multicenter study of postoperative deep-vein thrombosis in patients with haemophilia undergoing major orthopaedic surgery. / Buckner, Tyler W.; Leavitt, Andrew D.; Ragni, Margaret; Kempton, Christine L.; Elaine Eyster, M.; Cuker, Adam; Lentz, Steven R.; Ducore, Jonathan; Leissinger, Cindy; Wang, Mike; Key, Nigel S.

In: Thrombosis and Haemostasis, Vol. 116, No. 1, 01.07.2016, p. 42-49.

Research output: Contribution to journalArticle

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T1 - Prospective, multicenter study of postoperative deep-vein thrombosis in patients with haemophilia undergoing major orthopaedic surgery

AU - Buckner, Tyler W.

AU - Leavitt, Andrew D.

AU - Ragni, Margaret

AU - Kempton, Christine L.

AU - Elaine Eyster, M.

AU - Cuker, Adam

AU - Lentz, Steven R.

AU - Ducore, Jonathan

AU - Leissinger, Cindy

AU - Wang, Mike

AU - Key, Nigel S.

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Perioperative clotting factor replacement is administered to reverse the inherent haemostatic defect in persons with haemophilia (PWH), potentially increasing their risk for developing venous thromboembolism (VTE) postoperatively. It was our objective to determine the prevalence of VTE in PWH undergoing total hip or knee arthroplasty (THA, TKA). Patients with haemophilia A or B who underwent THA or TKA were enrolled in this prospective, multicentre observational cohort study. Lower extremity venous duplex ultrasound was performed prior to surgery and 4-6 weeks after surgery. Eleven centres enrolled 51 subjects, 46 of whom completed the study. Six subjects (13.0 %) were treated with bypass agents perioperatively; the remaining 40 subjects received factor VIII or IX replacement. Intermittent pneumatic compression devices were utilised postoperatively in 23 subjects (50 %), and four subjects (8.7 %) also received low-molecular-weight heparin prophylaxis. One subject (2.2 %) with moderate haemophilia A was diagnosed with symptomatic distal deep-vein thrombosis (DVT) on day 6 following TKA. One subject (2.2 %) with severe haemophilia A was diagnosed with pulmonary embolism on day 9 following bilateral TKA. No subjects had asymptomatic DVT. Eighteen subjects (39.1 %) had major bleeding, and three subjects (6.5 %) experienced minor bleeding. The observed prevalence of ultrasound-detectable, asymptomatic DVT in PWH following TKA or THA in this study was low, but the incidence of symptomatic VTE (4.3 %, 95 % CI, 0.5-14.8 %) appeared similar to the estimated incidence in the general population without thromboprophylaxis.

AB - Perioperative clotting factor replacement is administered to reverse the inherent haemostatic defect in persons with haemophilia (PWH), potentially increasing their risk for developing venous thromboembolism (VTE) postoperatively. It was our objective to determine the prevalence of VTE in PWH undergoing total hip or knee arthroplasty (THA, TKA). Patients with haemophilia A or B who underwent THA or TKA were enrolled in this prospective, multicentre observational cohort study. Lower extremity venous duplex ultrasound was performed prior to surgery and 4-6 weeks after surgery. Eleven centres enrolled 51 subjects, 46 of whom completed the study. Six subjects (13.0 %) were treated with bypass agents perioperatively; the remaining 40 subjects received factor VIII or IX replacement. Intermittent pneumatic compression devices were utilised postoperatively in 23 subjects (50 %), and four subjects (8.7 %) also received low-molecular-weight heparin prophylaxis. One subject (2.2 %) with moderate haemophilia A was diagnosed with symptomatic distal deep-vein thrombosis (DVT) on day 6 following TKA. One subject (2.2 %) with severe haemophilia A was diagnosed with pulmonary embolism on day 9 following bilateral TKA. No subjects had asymptomatic DVT. Eighteen subjects (39.1 %) had major bleeding, and three subjects (6.5 %) experienced minor bleeding. The observed prevalence of ultrasound-detectable, asymptomatic DVT in PWH following TKA or THA in this study was low, but the incidence of symptomatic VTE (4.3 %, 95 % CI, 0.5-14.8 %) appeared similar to the estimated incidence in the general population without thromboprophylaxis.

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