Subclinical deep venous thrombosis observed in 10% of hemophilic patients undergoing major orthopedic surgery.

Abstract

To cite this article: Hermans C, Hammer F, Lobet S, Lambert C. Subclinical deep venous thrombosis observed in 10% of hemophilic patients undergoing major orthopedic surgery. J Thromb Haemost 2010; 8: 1138–40. Deep venous thrombosis (DVT) is a common postoperative complication in patients undergoing major orthopedic surgery of the lower limbs, such as total hip replacement (THR), total knee replacement (TKR) or hip fracture surgery (HFS). In the absence of thromboprophylaxis, subclinical venous thrombosis rates as high as 60% have been reported when using systematic bilateral phlebography after orthopedic surgery. As a result, routine pharmacological thromboprophylaxis with low-molecular-weight heparin (LMWH) or an alternative antithrombotic agent is strongly recommended in patients undergoing these procedures [1]. With the availability of efficient and safe clotting factor concentrates, THR, TKR as well as ankle arthrodesis are frequently performed in subjects with hemophilia suffering from chronic hemophilic arthropathy [2]. Yet, pharmacological prophylaxis of venous thromboembolism (VTE) in this patient group remains controversial. With the exception of retrospective case reports and small series, the incidence of VTE disease in hemophilic patients after major orthopedic surgery is still unclear. Despite the concern that pharmacological thromboprophylaxis might increase bleeding complications in these patients, no properly sized study has objectively evaluated the need, appropriate timing, dosage and duration of low-molecular weight heparin (LMWH) prophylaxis in this