Age appears to be directly correlated with increased hidden blood loss after total knee arthroplasty (TKA) in patients with hemophilia A, while tranexamic acid and factor VIII (FVIIII) infusion may decrease the risk of bleeding after the procedure, according to a recently published study in BMC Musculoskeletal Disorders.

TKA is a common treatment for hemophilia-related arthropathy, as it shows impressive results regarding function recovery and pain treatment. However, patients with hemophilia tend to suffer greater postoperative blood loss than the common population, which in turn leads to increased hospitalization costs and worse recovery.

Currently, there is a lack of information regarding the factors that influence increased TKA-related hidden blood loss in patients with hemophilia. Therefore, the authors aimed to study which factors increase or decrease the risk of blood loss after TKA in a population of 83 patients with hemophilia A in the Orthopedic Center of the First Affiliated Hospital of Zhejiang Chinese Medicine University.


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All patients included in the study were operated on by the same surgical team using standardized methods. FVIII levels were measured in all cases at the moment of admission and again several times after administering clotting factor concentrate to measure peak and valley FIIIV and FIX levels. 

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In vivo recovery (IVR) was calculated by dividing the actual increase of coagulation factor (in percentage points) between the expected increases in coagulation factor times 100. The authors utilized multivariate linear regression analysis to assess the influence of variables such as age tranexamic acid use, IVR, FVIII prophylaxis, and body mass index in hidden blood loss and total blood loss following TKA.

Bleeding rates in patients with hemophilia A were compared with those of patients with osteoarthritis, showing that these patients had significantly greater total blood loss and hidden blood loss after TKA.

The results showed that tranexamic acid use and FVIIII prophylaxis were associated with less bleeding in patients with hemophilia A after TKA and that an increasing IVR correlated negatively to bleeding. On the other hand, increasing age appeared to be an important risk factor correlating to more postoperative bleeding after TKA. Body mass index appeared to not correlate with bleeding.

The authors recommended both tranexamic acid use and FVIII prophylaxis for all patients with hemophilia A undergoing TKA, as well as IVR measuring. “Elderly patients have a greater risk of blood loss, and additional preventive measures can be appropriately added,” they concluded. 

Reference

Shen SN, Wu DX, Lv SJ, Tong PJ. Hidden blood loss of total knee arthroplasty in hemophilia arthritis: an analysis of influencing factors. BMC Musculoskelet Disord. Published online June 17, 2022 doi:10.1186/s12891-022-05535-y