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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Comparison of continuous infusion versus bolus injection of factor concentrates for blood management after total knee arthroplasty in patients with hemophilia

Authors: Young Shil Park, Won-Ju Shin, Kang-Il Kim

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

Total knee arthroplasty (TKA) has become the treatment of choice for end-stage hemophilic arthropathy of the knee. Theoretically in hemophilia A, perioperative continuous infusion (CI) of factor VIII (FVIII) would provide a more consistent FVIII level than general bolus injections (BI) in TKA. Current study was designed to evaluate the effectiveness of CI of coagulation factor concentrates during the perioperative period compared to BI.

Methods

A total of 42 TKAs were performed in 31 patients with severe hemophilia A. Under the supervision of a multidisciplinary hemophilia team, CI and BI were monitored during application of a standardized regimen. Perioperative clinical parameters including postoperative hemoglobin drop, drained blood volume, transfusion rate, total consumption of FVIII, and perioperative complications were assessed.

Results

The difference in the postoperative hemoglobin drop was significant between two groups with a lower decrease in the CI group (p = 0.002). The drained blood volume for postoperative 24 h was significantly lower in the CI than the BI groups (p = 0.037). Total consumption of factor concentrates for postoperative 5 days was greater in the CI group than in the BI group (p = 0.000). One postoperative hematoma and wound dehiscence occurred in BI group and no other complication developed.

Conclusions

Although good control of hemostasis could be achieved using either method during the perioperative period of TKA, CI seems more tolerable and effective than BI to provide perioperative blood management undergoing TKA in patients with hemophilia.

Trial registration

The study was retrospectively registered in WHO ICTRP under identifier KCT0002404 (date of registration: August 04, 2017).
Literature
1.
Goddard NJ, Mann HA, Lee CA. Total knee replacement in patients with endstage haemophilic arthropathy: 25-year results. J Bone Joint Surg Br. 2010;92:1085–9.CrossRefPubMed
2.
Panotopoulos J, Ay C, Trieb K, Schuh R, Windhager R, Wanivenhaus HA. Outcome of total knee arthroplasty in hemophilic arthropathy. J Arthroplast. 2014;29:749–52.CrossRef
3.
Silva M, Luck JV Jr. Long-term results of primary total knee replacement in patients with hemophilia. J Bone Joint Surg Am. 2005;87:85–91.PubMed
4.
Westberg M, Paus AC, Holme PA, Tjønnfjord GE. Haemophilic arthropathy: long-term outcomes in 107 primary total knee arthroplasties. Knee. 2014;21:147–50.CrossRefPubMed
5.
Batorova A, Martinowitz U. Intermittent injections vs. continuous infusion of factor VIII in haemophilia patients undergoing major surgery. Br J Haematol. 2000;110:715–20.CrossRefPubMed
6.
Martinowitz U, Schulman S, Gitel S, Horozowski H, Heim M, Varon D. Adjusted dose continuous infusion of factor VIII in patients with haemophilia a. Br J Haematol. 1992;82:729–34.CrossRefPubMed
7.
Martinowitz UP, Schulman S. Continuous infusion of factor concentrates: review of use in hemophilia a and demonstration of safety and efficacy in hemophilia B. Acta Haematol. 1995;94(Suppl. 1):35–42.CrossRefPubMed
8.
Meijer K, Rauchensteiner S, Santagostino E, Platokouki H, Schutgens RE, Brunn M, Tueckmantel C, Valeri F, Schinco PC. Continuous infusion of recombinant factor VIII formulated with sucrose in surgery: non-interventional, observational study in patients with severe haemophilia a. Haemophilia. 2015;21:e19–25.CrossRefPubMed
9.
Yoo MC, Cho YJ, Kim KI, Ramteke A, Chun YS. The outcome of cementless total hip arthroplasty in haemophilic hip arthropathy. Haemophilia. 2009;15:766–73.CrossRefPubMed
10.
Rana NA, Shapiro GR, Green D. Long-term follow-up of prosthetic joint replacement in hemophilia. Am J Hematol. 1986;23:329–37.CrossRefPubMed
11.
Karthaus RP, Novakova IR. Total knee replacement in haemophilic arthropathy. J Bone Joint Surg Br. 1988;70:382–5.PubMed
12.
Figgie MP, Goldberg VM, Figgie HE 3rd, Heiple KG, Sobel M. Total knee arthroplasty for the treatment of chronic hemophilic arthropathy. Clin Orthop Relat Res. 1989;248:98–107.
13.
Dingli D, Gastineau DA, Gilchrist GS, Nichols WL, Wilke JL. Continuous factor VIII infusion therapy in patients with haemophilia a undergoing surgical procedures with plasma-derived or recombinant factor VIII concentrates. Haemophilia. 2002;8:629–34.CrossRefPubMed
14.
Wong JM, Mann HA, Goddard NJ. Perioperative clotting factor replacement and infection in total knee arthroplasty. Haemophilia. 2012 Jul;18:607–12.CrossRefPubMed
15.
McMillan CW, Webster WP, Roberts HR, Blythe WB. Continuous intravenous infusion of factor VIII in classic haemophilia. Br J Haematol. 1970;18:659–67.CrossRefPubMed
16.
Batorova A, Martinowitz U. Continuous infusion of coagulation factors: current opinion. Curr Opin Hematol. 2006;13:308–15.CrossRefPubMed
17.
Takedani H. Continuous infusion during total joint arthroplasty in Japanese haemophilia a patients: comparison study among two recombinants and one plasma-derived factor VIII. Haemophilia. 2010;16:740–6.CrossRefPubMed
18.
Wallny TA, Strauss AC, Goldmann G, Oldenburg J, Wirtz DC, Pennekamp PH. Elective total knee arthroplasty in haemophilic patients. Proposal for a clinical pathway. Hamostaseologie. 2014;34(Suppl. 1):S23–9.CrossRefPubMed
19.
Schulman S, Gitel S, Martinowitz U. Stability of factor VIII concentrates after reconstitution. Am J Hematol. 1994;45:217–23.CrossRefPubMed
20.
Schulman S, Varon D, Keller N, Gitel S, Martinowitz U. Monoclonal purified F VIII for continuous infusion: stability, microbiological safety and clinical experience. Thromb Haemost. 1994;72:403–7.PubMed
21.
Lee M, Morfini M, Negrier C, Chamouard V. The pharmacokinetics of coagulation factors. Haemophilia. 2006;12(Suppl. 3):1–7.PubMed
22.
Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res. 2001;392:15–23.CrossRef
23.
Martinowitz U, Luboshitz J, Bashari D, Ravid B, Gorina E, Regan L, Stass H, Lubetsky A. Stability, efficacy, and safety of continuously infused sucrose-formulated recombinant factor VIII (rFVIII-FS) during surgery in patients with severe haemophilia. Haemophilia. 2009;15:676–85.CrossRefPubMed
24.
Rahmé M, Ehlinger M, Faradji A, Gengenwin N, Lecocq J, Sibilia J, Bonnomet F. Total knee arthroplasty in severe haemophilic patients under continuous infusion of clotting factors. Knee Surg Sports Traumatol Arthrosc. 2012;20:1781–6.CrossRefPubMed
25.
Auerswald G, Bade A, Haubold K, Overberg D, Masurat S, Moorthi C. No inhibitor development after continuous infusion of factor concentrates in subjects with bleeding disorders undergoing surgery: a prospective study. Haemophilia. 2013;19:438–44.CrossRefPubMed
26.
Rodriguez-Merchan EC. Special features of total knee replacement in hemophilia. Expert Rev Hematol. 2013;6:637–42.CrossRefPubMed
27.
Belgaumi AF, Patrick CC, Deitcher SR. Stability and sterility of a recombinant factor VIII concentrate prepared for continuous infusion administration. Am J Hematol. 1999;62:13–8.CrossRefPubMed
28.
von Auer C, Oldenburg J, von Depka M, Escuriola-Ettinghausen C, Kurnik K, Lenk H, Scharrer I. Inhibitor development in patients with hemophilia a after continuous infusion of FVIII concentrates. Ann N Y Acad Sci. 2005;1051:498–505.CrossRef
29.
Eckhardt CL, Mauser-Bunschoten EP, Peters M, Leebeek FW, van der Meer FJ, Fijnvandraat K. Inhibitor incidence after intensive FVIII replacement for surgery in mild and moderate haemophilia a: a prospective national study in the Netherlands. Br J Haematol. 2012;157:747–52.CrossRefPubMed
30.
Chevalier Y, Dargaud Y, Lienhart A, Chamouard V, Negrier C. Seventy-two total knee arthroplasties performed in patients with haemophilia using continuous infusion. Vox Sang. 2013;104:135–43.CrossRefPubMed
Metadata
Title
Comparison of continuous infusion versus bolus injection of factor concentrates for blood management after total knee arthroplasty in patients with hemophilia
Authors
Young Shil Park
Won-Ju Shin
Kang-Il Kim
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1720-0

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