26. Perioperative Thromboprophylaxis for Persons with Hemophilia Undergoing Orthopedic Surgery

  1. Emérito-Carlos Rodríguez-Merchán MD, PHD3,4 and
  2. Leonard A. Valentino MD5
  1. Gerard Dolan MB ChB, FRCP, FRCPath1,
  2. Donna M. DiMichele MD2 and
  3. Emérito-Carlos Rodríguez-Merchán MD, PHD3,4

Published Online: 12 MAY 2011

DOI: 10.1002/9781119979401.ch26

Current and Future Issues in Hemophilia Care

Current and Future Issues in Hemophilia Care

How to Cite

Dolan, G., DiMichele, D. M. and Rodríguez-Merchán, E.-C. (2011) Perioperative Thromboprophylaxis for Persons with Hemophilia Undergoing Orthopedic Surgery, in Current and Future Issues in Hemophilia Care (eds E.-C. Rodríguez-Merchán and L. A. Valentino), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119979401.ch26

Editor Information

  1. 3

    Department of Orthopedic Surgery and Hemophilia Unit, La Paz University Hospital, Spain

  2. 4

    School of Medicine, Autonomous University, Madrid, Spain

  3. 5

    Hemophilia and Thrombophilia Center, Rush University Medical Center, Chicago, IL, USA

Author Information

  1. 1

    Nottingham University Hospitals, Nottingham, UK

  2. 2

    Weill Cornell Medical College, New York, NY, USA

  3. 3

    Department of Orthopedic Surgery and Hemophilia Unit, La Paz University Hospital, Spain

  4. 4

    School of Medicine, Autonomous University, Madrid, Spain

Publication History

  1. Published Online: 12 MAY 2011
  2. Published Print: 13 MAY 2011

ISBN Information

Print ISBN: 9780470670576

Online ISBN: 9781119979401

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Keywords:

  • hemophilia;
  • orthopedic surgery;
  • thromboprophylaxis

Summary

The published literature suggests that VTE is an uncommon occurrence in persons with hemophilia with or without inhibitors who undergo orthopedic surgery. Consequently, few adaptive guidelines exist for thromboprophylaxis in this setting. However, an interesting feature of the reports of absence of VTE in hemophilia has been that many patients undergoing major joint surgery are of a relatively young age. Age is a significant risk factor for VTE and the hemophilia population is aging. In future, there will be many more older individuals undergoing orthopedic surgery as a result of hemophilic arthropathy, and many will live long enough to need revision surgery. It is also likely that more surgical procedures will be performed in this aging population for degenerative arthropathy such as osteoarthritis. There is therefore an urgent need to understand more about the risk of VTE in hemophilia and other bleeding disorders and to establish risk assessment tools applicable to this population. It is also important to establish the most effective and safest way to manage any risk and it is likely this will only be achieved through prospective observational studies requiring wide collaboration.