A single-centre study of haemostatic outcomes of joint replacement in von Willebrand disease and control patients and an analysis of the literature

L. Rugeri, Aneel Arjun Ashrani, W. L. Nichols, R. T. Trousdale, R. K. Pruthi

Research output: Contribution to journalArticle

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Abstract

Introduction: Haemostatic assessments of patients with von Willebrand disease (VWD) who undergo total knee arthroplasty (TKA) and total hip arthroplasty (THA) have mainly relied on subjective parameters. Aims: To compare objective haemostatic outcomes of TKA/THA in VWD patients and controls without bleeding disorders. Methods: We retrospectively analysed haemostatic outcomes in VWD patients undergoing TKA/THA from 1993 to 2011 and compared them with two matched controls per operation. Using one-way analysis of variance, we tested the effect of VWD on bleeding risk after TKA and THA. Results: Twelve VWD patients (6 type 1, 3 type 2M, 1 each of types 2A/2B/3) undergoing 19 operations (12 TKA, 7 THA) were matched to 38 controls. One (5%) of 19 operations in VWD patients and none of the control operations met clinical criteria for major bleeding. Baseline and postoperative day 1 haemoglobin levels, postoperative blood loss, transfused red blood cells (RBCs) and mean hospitalization days were not significantly different. More VWD patients than controls received RBC transfusions [12 (63%) vs. 12 (32%)]. Only 9 (47%) VWD patients vs. 38 (100%) controls received pharmacologic VTE prophylaxis. No postoperative symptomatic VTE occurred in either group. Conclusion: In this largest, single-institutional study, von Willebrand factor replacement based on daily levels resulted in low frequency of major bleeding in VWD patients after TKA/THA. RBC transfusion was more frequent compared with matched controls, but other objective measures of haemostasis were similar. Lack of sufficient details in published reports precluded comparison of haemostatic outcomes.

Original languageEnglish (US)
Pages (from-to)934-942
Number of pages9
JournalHaemophilia
Volume22
Issue number6
DOIs
StatePublished - Nov 1 2016

Fingerprint

Replacement Arthroplasties
von Willebrand Diseases
Hemostatics
Knee Replacement Arthroplasties
Outcome Assessment (Health Care)
Arthroplasty
Hip
Hemorrhage
Erythrocyte Transfusion
Postoperative Hemorrhage
von Willebrand Factor
Hemostasis
Analysis of Variance
Hemoglobins
Hospitalization
Erythrocytes

Keywords

  • arthroplasty, hip replacement
  • blood coagulation factors
  • blood transfusion
  • knee replacement
  • von Willebrand disease

ASJC Scopus subject areas

  • Hematology
  • Genetics(clinical)

Cite this

A single-centre study of haemostatic outcomes of joint replacement in von Willebrand disease and control patients and an analysis of the literature. / Rugeri, L.; Ashrani, Aneel Arjun; Nichols, W. L.; Trousdale, R. T.; Pruthi, R. K.

In: Haemophilia, Vol. 22, No. 6, 01.11.2016, p. 934-942.

Research output: Contribution to journalArticle

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abstract = "Introduction: Haemostatic assessments of patients with von Willebrand disease (VWD) who undergo total knee arthroplasty (TKA) and total hip arthroplasty (THA) have mainly relied on subjective parameters. Aims: To compare objective haemostatic outcomes of TKA/THA in VWD patients and controls without bleeding disorders. Methods: We retrospectively analysed haemostatic outcomes in VWD patients undergoing TKA/THA from 1993 to 2011 and compared them with two matched controls per operation. Using one-way analysis of variance, we tested the effect of VWD on bleeding risk after TKA and THA. Results: Twelve VWD patients (6 type 1, 3 type 2M, 1 each of types 2A/2B/3) undergoing 19 operations (12 TKA, 7 THA) were matched to 38 controls. One (5{\%}) of 19 operations in VWD patients and none of the control operations met clinical criteria for major bleeding. Baseline and postoperative day 1 haemoglobin levels, postoperative blood loss, transfused red blood cells (RBCs) and mean hospitalization days were not significantly different. More VWD patients than controls received RBC transfusions [12 (63{\%}) vs. 12 (32{\%})]. Only 9 (47{\%}) VWD patients vs. 38 (100{\%}) controls received pharmacologic VTE prophylaxis. No postoperative symptomatic VTE occurred in either group. Conclusion: In this largest, single-institutional study, von Willebrand factor replacement based on daily levels resulted in low frequency of major bleeding in VWD patients after TKA/THA. RBC transfusion was more frequent compared with matched controls, but other objective measures of haemostasis were similar. Lack of sufficient details in published reports precluded comparison of haemostatic outcomes.",
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N2 - Introduction: Haemostatic assessments of patients with von Willebrand disease (VWD) who undergo total knee arthroplasty (TKA) and total hip arthroplasty (THA) have mainly relied on subjective parameters. Aims: To compare objective haemostatic outcomes of TKA/THA in VWD patients and controls without bleeding disorders. Methods: We retrospectively analysed haemostatic outcomes in VWD patients undergoing TKA/THA from 1993 to 2011 and compared them with two matched controls per operation. Using one-way analysis of variance, we tested the effect of VWD on bleeding risk after TKA and THA. Results: Twelve VWD patients (6 type 1, 3 type 2M, 1 each of types 2A/2B/3) undergoing 19 operations (12 TKA, 7 THA) were matched to 38 controls. One (5%) of 19 operations in VWD patients and none of the control operations met clinical criteria for major bleeding. Baseline and postoperative day 1 haemoglobin levels, postoperative blood loss, transfused red blood cells (RBCs) and mean hospitalization days were not significantly different. More VWD patients than controls received RBC transfusions [12 (63%) vs. 12 (32%)]. Only 9 (47%) VWD patients vs. 38 (100%) controls received pharmacologic VTE prophylaxis. No postoperative symptomatic VTE occurred in either group. Conclusion: In this largest, single-institutional study, von Willebrand factor replacement based on daily levels resulted in low frequency of major bleeding in VWD patients after TKA/THA. RBC transfusion was more frequent compared with matched controls, but other objective measures of haemostasis were similar. Lack of sufficient details in published reports precluded comparison of haemostatic outcomes.

AB - Introduction: Haemostatic assessments of patients with von Willebrand disease (VWD) who undergo total knee arthroplasty (TKA) and total hip arthroplasty (THA) have mainly relied on subjective parameters. Aims: To compare objective haemostatic outcomes of TKA/THA in VWD patients and controls without bleeding disorders. Methods: We retrospectively analysed haemostatic outcomes in VWD patients undergoing TKA/THA from 1993 to 2011 and compared them with two matched controls per operation. Using one-way analysis of variance, we tested the effect of VWD on bleeding risk after TKA and THA. Results: Twelve VWD patients (6 type 1, 3 type 2M, 1 each of types 2A/2B/3) undergoing 19 operations (12 TKA, 7 THA) were matched to 38 controls. One (5%) of 19 operations in VWD patients and none of the control operations met clinical criteria for major bleeding. Baseline and postoperative day 1 haemoglobin levels, postoperative blood loss, transfused red blood cells (RBCs) and mean hospitalization days were not significantly different. More VWD patients than controls received RBC transfusions [12 (63%) vs. 12 (32%)]. Only 9 (47%) VWD patients vs. 38 (100%) controls received pharmacologic VTE prophylaxis. No postoperative symptomatic VTE occurred in either group. Conclusion: In this largest, single-institutional study, von Willebrand factor replacement based on daily levels resulted in low frequency of major bleeding in VWD patients after TKA/THA. RBC transfusion was more frequent compared with matched controls, but other objective measures of haemostasis were similar. Lack of sufficient details in published reports precluded comparison of haemostatic outcomes.

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