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Risk of deep venous thrombosis after total knee arthroplasty in patients with haemophilia A
Author(s) -
Ono Kumiko,
Takedani Hideyuki
Publication year - 2020
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/hae.14095
Subject(s) - medicine , haemophilia , surgery , venous thrombosis , thrombosis , haemophilia b , arthroplasty , total knee arthroplasty , deep vein , arthropathy , haemophilia a , clotting factor , radiology , osteoarthritis , alternative medicine , pathology
Venous thromboprophylaxis remains controversial in patients with haemophilia undergoing major orthopaedic surgery, due to clotting factor replacement therapy to correct the patient's inherent haemostatic defect during procedure, at least in theory. We have previously reported that deep venous thrombosis (DVT) was not detected on ultrasonography (US) after total knee arthroplasty (TKA) in 36 Japanese patients with haemophilia. Aim To evaluate the prevalence of DVT after TKA among haemophilic A patients using not only US, but also contrast‐enhanced CT prospectively. Methods This study enrolled 11 TKAs in 11 Japanese patients with haemophilia A not having any history of inhibitor. A pneumatic compression device was used from the beginning of the operation until the patient could perform standing exercises (day 2). US of the lower extremities was performed before and after surgery (day 2) to detect DVT. Contrast‐enhanced CT was performed after surgery (day 7) to detect VTE. D‐dimer was measured at pre‐ and postoperative time. Results Mean (±standard deviation) age at the time of operation was 50.5 ± 12.3 years. DVT was not found on either pre‐ or postoperative examinations by US, but contrast‐enhanced CT was detected DVT in two cases. No patients showed clinical signs for VTE during hospitalization, and no additional treatment for VTE. No episodes of unexpected bleeding were encountered. Conclusion Contrast‐enhanced CT detected DVT in 18% of haemophilia A patients who underwent TKA despite no detection of DVT on US. We must consider how to prevent and treat VTE in patients with haemophilia scheduled to undergo orthopaedic surgery.