Hemophilia A patients undergoing total hip or knee replacement/reconstruction surgeries have lesser blood loss and require a lower transfusion amount if treated with Cyklokapron (tranexamic acid), a study reports.
They also are likely to experience less joint pain or swelling and better joint function, and have lower levels of inflammatory markers.
The research, “Tranexamic acid may benefit patients undergoing total hip/knee arthroplasty because of haemophilia,” appeared in the journal BMC Musculoskeletal Disorders.
Total hip/knee arthroplasty — a surgery to restore joint function by replacement or reconstruction — is a common surgery for hemophilia patients with arthropathy (joint disease). However, as blood loss is a possible complication of this procedure, these people could be at a higher risk due to their impaired blood clotting.
Cyklokapron, by Pfizer, prevents blood loss by binding to plasminogen and blocking the formation of fibrin, a protein that degrades clots. However, whether it benefits hemophilia patients undergoing such joint surgery remains unknown.
A team at West China Hospital, SiChuan University, reviewed its data on the use of Cyklokapron or its non-use in hemophilia A patients from January 2008 to August 2017. Among a total of 34 men, 14 underwent unilateral knee surgery, 12 unilateral hip surgery, five had a bilateral knee procedure, and the remaining three underwent bilateral hip surgery.
One day prior to surgery, all patients were given clotting factor VIII (FVIII) — the protein missing in people with hemophilia A — with its activity being monitored before and over four hours after the procedure.
Cyklokapron was given intravenously five to 10 minutes before the start of surgery (20 mg/kg), and again three, six, 12, and 24 hours later (10 mg/kg) along with topical therapy (1 g). After discharge, these patients were examined at one month, six months and once every year thereafter, for an average follow-up of 68 months.
Patients taking Cyklokapron did not differ from those not taking this treatment regarding mean age (38.9, vs. 37.2 years), disease severity — 17 men had severe disease, as determined by the level of FVIII; seven were given Cyklokapron — platelet count, or duration of surgery.
Treatment with Cyklokapron was associated with lower intraoperative (264 vs. 397 mL) and total blood loss (935 vs. 1,464 mL), as well as reduced drainage volume (236 vs. 354 mL) and a lower amount of supplement FVIII during the preoperative period (36,328 vs. 42,125 IU).
Patients not using Cyklokapron showed a higher maximum change in the level of hemoglobin, the protein carrying oxygen in red blood cells (32 vs. 22 g/L). Among this group, 11 patients (61%) needed a transfusion — and a larger amount of blood transfused — in contrast to three (19%) among the men receiving this therapy.
The group receiving Cyklokapron also reported less pain in the affected joint throughout the hospital stay, and had less knee and hip swelling. Levels of the inflammatory markers C-reactive protein and interleukin-6 were lower with Cyklokapron treatment over much of the first week post-surgery (days 1 to 5).
Improvements in knee and hip function, as assessed by range of motion, were more significant in the Cyklokapron group throughout follow-up. Specifically, both flexion/extension and internal/external-rotation of the hip were found to be better in patients taking Cyklokapron.
Regarding complications, no patient on Cyklokapron experienced leakage from the wound site. One person in this group had a hemorrhage three months post-surgery due to too much activity. Four among those not given this treatment reported blistering. No cases of joint infection or deep vein thrombosis (blood clot) occurred in either group.
All patients were satisfied at final follow-up — as measured on a 7-point scale — and all agreed to undergo repeat surgery.
“The most important finding of the present study was that usage of [Cyklokapron] can decrease not only the perioperative blood loss, transfusion rate and supplemental amount of FVIII but also swelling ratio and surgical joint pain,” the researchers wrote.
They noted more studies are needed to assess the long-term effects of Cyklokapron in these patients.