Tranexamic Acid - Major Antifibrinolytic Agent Used to Achieve Hemostasis in Hemophilic Patients with Anti-Factor VIII Anti-Bodies Who Must Undergo Total Joint Replecement

Abstract

Hemophilia is a congenital coagulopathy characterized by a deficiency of coagulation factor VIII or IX. The main complication of this hemopathy is represented by the hemorrhagiparous phenomena that affect mainly the musculoskeletal system. Of the various chronic complications of this condition, hemarthrosis is responsible for the onset of chronic arthropathy, which is a disabling condition. In addition to hematologist-prescribed coagulation factor replacement therapy, acute hemarthrosis and chronic arthropathy management requires close collaboration with both orthopedic surgeons and physiotherapists. This multidisciplinary collaboration is essential both to prevent the onset of hemarthroses and to manage acute bleeding episodes, to assess joint function and to effectively treat hemophilic chronic arthropathy. Hemophilic arthropathy causes significant joint instability and reduced mobility or even total ankylosis, which may lead to permanent disability and hence to a decrease in the patient�s quality of life. From an orthopedic point of view, disabling hemophilic arthropathy may be treated by surgery. Achieving effective hemostasis is vital in order to be able to perform these extremely difficult surgical procedures, due to the high risk of bleeding. This paper aims at highlighting the hemostatic efficacy of tranexamic acid in orthopedic surgery in hemophilic patients who must undergo total joint replacement.