OC 12.3 - Rates of Venous Thromboembolism and use of thromboprophylaxis after major orthopedic surgery in patients with congenital Hemophilia A or B: a systematic review

Sunday, June 25, 2023

11:15 – 11:30 ET

Room: 710A

Session Available As: On-Demand

Presenting Author(s)

Davide Santagata, MD (he/him/his)

Resident
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Como, Lombardia, Italy

Co-Author(s)

AA

Alessia Abenante

Resident
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Varese, Lombardia, Italy
Alessandro Squizzato

Professor of Internal Medicine, Head of the Internal Medicine ward ASST Lariana, San Fermo
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Como, Lombardia, Italy
MD

Marco Paolo Donadini, MD, PhD

Professor of Internal Medicine
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Varese, Lombardia, Italy
FD

Francesco Dentali

Professor of Internal Medicine, Head of the Internal Medicine ward ASST Sette Laghi, Varese
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Varese, Lombardia, Italy
Walter Ageno, MD (he/him/his)

Professor of Medicine
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Varese, Lombardia, Italy
Ingrid Pabinger, MD

Co-Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
Andreas Tiede, MD PhD (he/him/his)

Professor of Hemostasis and Thrombosis
Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
Hannover, Niedersachsen, Germany
Cihan Ay, MD (he/him/his)

Professor, Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria

Background: Venous thromboembolism (VTE) is a well-recognized complication after total-joint replacement (TJR). Patients with hemophilia A or B are considered at low postoperative VTE risk due to their coagulation factor deficiencies and administering pharmacological thromboprophylaxis is often considered contraindicated. However, using factor replacement therapy could increase the postoperative VTE risk. Hence, using thromboprophylaxis in these patients remains controversial.

Aims: To analyze the best available evidence of VTE rates in patients with hemophilia A or B undergoing lower limb TJR and the use of postoperative pharmacological thromboprophylaxis.

Methods: We performed a systematic review and searched for studies in four online databases (PubMed, EMBASE, Scopus, and Web of Science) reporting VTE in patients with hemophilia after TJR. Case reports and case series with less than ten patients were excluded. The target population was patients with hemophilia who had TJR surgeries. The main outcome was the VTE rate. Study quality was evaluated to assess the risk of bias.

Results: Twenty-nine observational studies were included in this systematic review, reporting 1245 TJR in patients with hemophilia A or B (Table 1). Nine studies had VTE rates as the primary outcome. In five studies, screen-detected VTE was reported as outcome, while 24 papers reported symptomatic VTE events. Overall, 17 VTE were reported (0.9%, 95% CI 0.3%-2.3%); 10 events after 151 (6.6%) surgeries with postoperative VTE screening and 7 symptomatic events in 1094 (0.6%) surgeries without postoperative screening. Thromboprophylaxis protocols were specified in 24 studies; in 37/1245 (3.0%) surgeries postoperative thromboprophylaxis was used. This information was not available for 342/1245 surgeries (27.5 %).

Conclusion(s): Despite the low thromboprophylaxis use in patients with hemophilia, the overall rate of symptomatic VTE after TJR appeared to be low. Further studies are needed to better investigate VTE risk in this setting and identify patients requiring adequate prophylactic strategies.

Learning Objectives:

Upon completition, partecipant will be able to acquire new insight about the rates of Venous Thromboembolism events in patients with Hemophilia after total joint replacement surgeries.
Upon completition, partecipant will be able to reflect about the use of thromboprophylaxis after total joint replacement surgeries and to discuss about its usefulness in patient with Haemophilia.
Upon completion, participants will be able to recognize the importance of better reporting on venous thromboembolism outcomes in papers regarding post-operative outcomes in patients with Haemophilia.