The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Is Pharmacologic Prophylaxis for Venous Thromboembolism Necessary in People With Hemophilia After Total Knee and Hip Arthroplasty?

Document Type : CURRENT CONCEPTS REVIEW

Authors
E. Carlos RODRIGUEZ-MERCHAN 1
Hortensia De la Corte-Rodriguez 2
William J. Ribbans 3
1 Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain
2 Department of Physical Medicine and Rehabilitation; La Paz University Hospital, Madrid, Spain
3 Faculty of Health, Education and Society, University of Northampton, Northampton, UK and the County Clinic, UK
10.22038/abjs.2025.88708.4023
Abstract
Pharmacologic thromboprophylaxis for postoperative venous thromboembolism (VTE) after total knee arthroplasty (TKA) and total hip arthroplasty (THA) in people with hemophilia (PWH) is highly controversial. In PWH the prevalence of symptomatic VTE after TKA and THA is between 0 to 5%, while the prevalence of asymptomatic VTE is between 7.5% and 10%. In PWH many clinicians have not used pharmacologic thromboprophylaxis. Others have used low molecular weight heparin (LMWH) and reduced doses of DOAC [direct oral anticoagulants (thrombin inhibitors and Factor Xa inhibitors)]. It appears that pharmacologic thromboprophylaxis should only be carried out in PWH undergoing TKA and THA who have VTE risk factors [e.g., old age, prior VTE, varicose veins, general anesthesia, cancer, Factor V (Leiden) mutation, and obesity]. After TKA and THA in PWH, early mobilization is essential. Some authors have advocated additional mechanical thromboprophylaxis (pneumatic compression devices). In conclusion, for all PWH experiencing TKA and THA mechanical prophylaxis is sensible. Some form of pharmacologic prophylaxis should be strongly considered for PWH with clear risk factors. The main area of doubt is in PWH without risk factors. More prospective multicenter studies are required. Difficulties will be getting agreement on universal regimes to be followed; and the relatively small numbers of PWH experiencing TKA and THA.
        Level of evidence: III
Keywords
Hemophilia
Mechanical thromboprophylaxis
Pharmacologic thromboprophylaxis
Postoperative venous thromboembolism
Total hip arthroplasty
Total knee arthroplasty
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 2
February 2026
Pages 98-103

  • Receive Date 02 June 2025
  • Revise Date 31 January 2026
  • Accept Date 23 June 2025