Pharmacokinetic-guided versus weight-guided coagulation factor replacement in hemophilia patients undergoing arthroplasty: a retrospective real-world study on perioperative bleeding risk and economic outcomes.

OBJECTIVE

This study aimed to compare the perioperative bleeding risk and economic outcomes of pharmacokinetic (PK)-guided versus weight-guided coagulation factor replacement regimens during the perioperative period for patients with hemophilia undergoing joint arthroplasty.

METHOD: We conducted a retrospective analysis of clinical data from patients with hemophilia who underwent knee or hip joint arthroplasty at our center between 2013 and 2025.

RESULTS

Thirty-three male patients with a median age of 39 years were included. Twenty-five patients (75.8%) had severe hemophilia. Seventeen patients (51.5%) underwent total joint arthroplasty, and 16 (48.5%) underwent partial joint arthroplasty. Perioperative coagulation factor replacement was weight-guided in 22 patients (66.7%) and PK-guided in 11 patients (33.3%). Postoperative SF-6Dv2 scores indicated a significant improvement in quality of life compared to preoperative baselines. The PK-guided group demonstrated a significantly lower median hospitalization cost (138,232 RMB vs. 200,122 RMB, p = 0.0073) and lower median coagulation factor consumption (701.6 IU/kg vs. 892.9 IU/kg, p = 0.0304) compared to the weight-guided group. Median intraoperative blood loss and perioperative hemoglobin decrease were comparable between groups.

CONCLUSION

For patients with hemophilia undergoing joint arthroplasty, a PK-guided coagulation factor infusion regimen significantly reduced factor consumption and overall medical costs, without a statistically significant increase in perioperative bleeding risk compared with the weight-guided approach. These exploratory findings support the clinical and economic advantages of PK-guided management in this surgical setting and warrant confirmation in larger, prospective studies.