Effect Of Coagulation Factor ? Activity On Bleeding And Coagulation In Patients With Hemophilia A Knee Arthritis Undergoing Total Knee Arthroplasty

Objective:To investigate the effect of coagulation factor viii activity on bleeding and coagulation in patients with hemophilia A knee arthritis undergoing total knee arthroplasty.Methods:From April 2016 to March 2018,seven male hemophilia A patients were treated in our hospital.They were divided into two groups: group A,aged 24-49 years,with an average age of 33 years,and group B,aged 22-54 years,with an average age of 31 years.The two groups of patients with perioperative coagulation factor replacement preparation were "human coagulation factor v iii" produced by Shandong Taibang Company.The target activity levels of F ? before operation were 100% and 60%,respectively.Postoperative coagulation factor replacement therapy is as follows:Group A: maintain the activity of F ? 80%-100% on the 1-3 days after operation;60%-80% on the 4-6 days after operation;40%-60% on the 7th to 14 th days after operation.Group B: maintain the activity of F ? 50%-60% on the 1-3 days after operation;40%-50% on the 4-6 days after operation;30%-40% on the 7th to 14 th days after operation.Blood routine examination and thromboelastogram were performed on the 5th day after operation.Hemoglobin reduction,total blood loss,coagulation factor activity and comprehensive coagulation index were compared between the two groups.Results:There was no significant difference in hemoglobin reduction,total blood loss and coagulation factor activity between the two groups(P>0.05).The combined coagulation index of group B was significantly lower than that of group A(P<0.05),the difference is statistically significant.1 patient in group B developed pseudoaneurysm of left popliteal artery 20 days after operation.After conservative treatment,good recovery is achieved after increasing the amount of coagulation factor.All the 7 patients were followed up for 2-24 months(mean 14 months).There were no complications such as prosthetic loosening and periprosthetic infection during the follow-up period.Conclusion: It is safe and feasible for hemophilia A patients to control coagulation factor viii activity at a lower level(60%)before total knee arthroplasty.Reducing the use of coagulation factor in perioperative period has positive significance in reducing the risk of thrombosis and reducing the economic burden of patients.