Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: A prospective multicenter observational study.
Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: A prospective multicenter observational study.
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DOI：
10.1111/jth.15654
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发表时间：
2022-04
期刊：
影响因子：
--
通讯作者：
Buckner TW
中科院分区：
文献类型：
--
作者：
Kleiboer B;Layer MA;Cafuir LA;Cuker A;Escobar M;Eyster ME;Kraut E;Leavitt AD;Lentz SR;Quon D;Ragni MV;Thornhill D;Wang M;Key NS;Buckner TW
血友病患者(PWH)有患慢性血友病关节病(HA)的风险。关节置换手术可用于缓解顽固性疼痛和/或恢复关节功能。这项多中心、前瞻性、观察性队列研究评估了全髋关节置换(THA)或膝关节置换(TKA)术后期间的出血率。我们纳入了接受全髋关节置换术或全膝关节置换术的18岁的≥患者。临床决定由治疗医生根据当地的护理标准酌情作出。前瞻性记录临床数据。大出血被定义为危重部位的出血，在任何24小时内导致血红蛋白下降2g/dL或更多的出血，或输注两个或更多单位的压缩红细胞。共行131次手术，其中全膝关节置换术98例，全膝关节置换术33例，其中合并大出血39例(29.8%)，其中全膝关节置换术46%，全膝关节置换术25%。与TKA相比(OR 2.50，p=0.05)、存在抑制剂(OR 4.29，p=0.04)、增加BMI(与正常BMI相比，超重和肥胖的OR分别为4.49和6.09，P均<0.01)以及未使用抗纤溶药物(OR 3.00，p=0.03)，THA组大出血的风险增加。持续的凝血因子输注(与团注相比)或药物血栓预防都与出血风险无关。威斯康星患者行全髋关节置换术和全膝关节置换术后的出血风险仍然很大，尽管这些因素被替代了。使用抗纤溶药物与降低风险相关。
Persons with hemophilia (PWH) are at risk for chronic hemophilic arthropathy (HA). Joint replacement surgery may be used to relieve intractable pain and/or restore joint function. This multicenter, prospective, observational cohort study evaluated the rate of bleeding during the postoperative period after total hip (THA) or knee arthroplasty (TKA). We included PWH of any severity ≥18 years of age who were undergoing THA or TKA. Clinical decisions were made at the discretion of the treating physician according to local standards of care. Clinical data were prospectively recorded. Major bleeding was defined as bleeding in a critical site, bleeding that resulted in either a 2 g/dL or greater decrease in hemoglobin during any 24-hour period, or transfusion of two or more units of packed red blood cells. One hundred thirty-one procedures (98 TKA and 33 THA) were performed, 39 (29.8%) of which were complicated by major bleeding, including 46% of THA and 25% of TKA. The risk of major bleeding was increased in THA compared to TKA (OR 2.50, p=0.05), and by the presence of an inhibitor (OR 4.29, p=0.04), increased BMI (OR 4.49 and 6.09 for overweight and obese, respectively, compared to normal BMI, each p<0.01), and non-use of an antifibrinolytic medication (OR 3.00, p=0.03). Neither continuous clotting factor infusion (versus bolus infusion) nor pharmacologic thromboprophylaxis were associated with bleeding risk. The bleeding risk remains substantial after THA and TKA in PWH, despite factor replacement. Use of antifibrinolytic medications is associated with decreased risk.
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影响因子：
3.1
作者：
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通讯作者：
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影响因子：
2.5
作者：
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影响因子：
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影响因子：
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作者：
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通讯作者：
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DOI：
10.5435/00124635-201112000-00007
发表时间：
2011-12-01
影响因子：
3.2
作者：
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通讯作者：
Sluka, Patrick