In hemophilia patients who have undergone TKR surgery, pharmacological thromboembolic prophylaxis is a controversial issue although it is usual for patients who do not suffer from hemophilia. With the recommended clotting factor levels of 100% for 2 weeks after a knee replacement, it is likely that hemophilic patients are as prone to have deep vein thrombosis as nonhemophilic patients. In hemophilia, the best form of prophylaxis is the early mobilization of patients after the operation, which minimizes the risk of a deep vein thrombosis, which could be complicated by a pulmonary embolism.
The review of literature in TKR in nonhemophilia patients leads us to the conclusion that we cannot currently recommend thromboprophylaxis extensively in hemophilia patients undergoing TKR. In fact, we have never performed thromboprophylaxis (although we have always practiced rapid postoperative mobilization of patients after TKR). This sharply contrasts with what the literature recommends for nonhemophilia patients: mixed pharmacological and mechanical thromboprophylaxis is highly recommended. However, my opinion is that if we detect several risk factors for thromboembolism in a hemophiliac patient who is to undergo TKR, we should carry out the same type of thromboprophylaxis recommended for nonhemophilia patients.
Expert Rev Hematol. 2013;6(6):637-642. © 2013 Expert Reviews Ltd.