Features of hemostasis in patients with hemophilic arthropathy of the knee joint in the perioperative period

Background. Today, hemophilia is considered a hematological-orthopedic disease that develops as a result of damage to various anatomical structures of the musculoskeletal system among which the synovial joints, the so-called target joints, dominate in almost all patients with hemophilia. The aim of our study was to analyze the influence of the level of coagulation factors in patients with hemophilic arthropathies of the knee joint in different periods of surgical treatment. Materials and methods. To carry out our research, we analyzed data from 77 patients with hemophilia who underwent inpatient and outpatient treatment at the MNPE “Kyiv City Clinical Hospital 9” from 2008 to 2022. The first group included 43 (55.8 %) patients who underwent surgical synovectomy. The second group comprised 34 (44.2 %) patients who underwent total knee arthroplasty. Results. In our study, the coagulation factor level in the preoperative period was 1.66 ± 0.15 IU/ml in the first group, and 1.83 ± 0.15 IU/dl in the second group. Before surgery, all patients were administered coagulation factor VIII at a dose of 50 IU/kg of body weight. As a result, during surgery, the coagulation factor level was 92.6 ± 2.0 IU/dL in the first group, and 98.5 ± 2.2 IU/dL in the second group. These mean levels of factor VIII deficiency are a typical predicted response to administration of recombinant factor VIII concentrate. Such content of coagulation factor VIII corresponded to the normal level of coagulation factor VIII during surgery and did not require intraoperative correction. In the postoperative period, there was a significant decrease in the level of coagulation factor VIII to 69.3 ± 1.4 IU/dl in patients of the first group and 75.3 ± 1.5 IU/dl in the second group. Such a drop in the postoperative period is natural, taking into account the typical pharmacokinetics of coagulation factor VIII preparations in patients with hemophilia. Conclusions. Given the obtained indicators of coagulation factor VIII, as well as the peculiarities of the pharmacokinetics of its recombinant drug, patients of both observation groups were administered a maintenance dose of 25 IU/kg in the postoperative period.