Abstract Number: PB1014
Meeting: ISTH 2020 Congress
Theme: Hemophilia and Rare Bleeding Disorders » Hemophilia - Clinical
Background: Deep venous thrombosis (DVT) is a common postoperative complication in patients undergoing major orthopedic surgery of the lower limbs, such as total hip or knee replacement (THR, TKR). Routine pharmacological thromboprophylaxis with low-molecular-weight heparin (LMWH) or a direct oral anticoagulant agent is strongly recommended in patients undergoing these procedures. THR and TKR as well as ankle arthrodesis are frequently performed in people with hemophilia (PWH) suffering from chronic hemophilic arthropathy. Pharmacological thromboprophylaxis in this population remains controversial.
Aims: Identify the incidence of subclinical DVT in PWH undergoing major orthopedic surgery.
Methods: We report the results of a prospective study initiated in 2002 at the Cliniques universitaires Saint-Luc, Brussels, evaluating by systematic bilateral US-Doppler imaging the incidence of subclinical DVT in consecutive PWH referred for major orthopedic surgery and not receiving pharmacological thromboprophylaxis.
Results: The study included 45 different PWH (38 HA, 7 HB, 26 severe, 15 moderate and 4 mild forms) undergoing 66 orthopedic procedures of the lower limbs. Most procedures (89%) were performed with continuous infusion of clotting factor concentrates. Almost all patients received tranexamic acid on the day of surgery, wore compression stockings and started rehabilitation on day 1 post-op. No case of clinical DVT or PE was suspected. In total there were 5 cases (3 severe -1 moderate HA -1 moderate HB) of subclinical DVT which all were distal, not complicated by clinically patent PE. Two patients were treated with a short course (10-14 days) of LMWH and 3 had a spontaneous resolution. The overall incidence of DVT was 7.5% for all the procedures.
Conclusions: These data provide imaging-based evidence that the risk of DVT following major orthopedic surgery among PWH is low. Identified distal DVTs were distal and resolved spontaneously in most cases. Systematic pharmacological thromboprophylaxis in this specific population is probably for most patients not required.
To cite this abstract in AMA style:
Verstraete G, Lambert C, Hammer F, Hermans C. Subclinical deep venous thrombosis identified in 7,5% of people with hemophilia undergoing major orthopedic surgery in the absence of pharmacological thromboprophylaxis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/subclinical-deep-venous-thrombosis-identified-in-75-of-people-with-hemophilia-undergoing-major-orthopedic-surgery-in-the-absence-of-pharmacological-thromboprophylaxis/. Accessed October 1, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/subclinical-deep-venous-thrombosis-identified-in-75-of-people-with-hemophilia-undergoing-major-orthopedic-surgery-in-the-absence-of-pharmacological-thromboprophylaxis/