Thromboprophylaxis in haemophilia patients undergoing orthopaedic surgery.

The review of literature on thromboprophylaxis in nonhaemophilia patients undergoing orthopaedic surgery and on thromboprophylaxis in people with haemophilia undergoing orthopaedic surgery leads us to the conclusion that we cannot currently recommend thromboprophylaxis extensively in haemophilia patients undergoing orthopaedic surgery. This sharply contrasts with what the literature recommends for nonhaemophilia patients, that is to say mixed pharmacological and mechanical thromboprophylaxis. However, if we detect several risk factors for thromboembolism in a haemophiliac patient who is to undergo orthopaedic surgery, we should carry out the same type of thromboprophylaxis recommended for nonhaemophilia patients. Such risk factors are the following: orthopaedic surgery, increased age, previous thromboembolism, varicose veins, general anaesthesia, malignancy (cancer), factor V (Leiden) mutation, obesity, and the oral contraceptive pill (in women with von Willebrand disease).