Efficiency of Tranexamic Acid in Management of Surgical Orthopedic Bleeding in Patients with Haemophilia

Haemophilia is an inherited bleeding disorder (gonosomala recessive, related to chromosome X, with transmission from carrying women to male descendents) characterised from the clinic point of view by important bleeding, secondary to some minimum and biologic traumas by deficiency of trombo-plastino-formation, consecutive to either a deficit of factor VIII (haemophilia A), or the factor IX (haemophilia B). The most characteristic manifestation of hemophilia is intra-articular - hemarthrosis. Its repetitive character leads to irreversible lesions of the articular structures, inducing lesions of the synovium with degenerative effects over the articular cartilage and destructive effects for the subchondral bone tissue. In time, these lesions require orthopaedic surgery to improve the locomotor activity. Managing an efficient hemostasis is vital during surgery, due to high risk of bleeding triggered by coagulopathy and surgery. Numerous studies carried out underlined the efficiency of the tranexamic acid (TXA) in reducing bleeding, in different surgery branches, by inhibiting the enzymatic degradation of fibrin. In orthopaedic surgery, the tranexamic acid is frequently used in case of hip and knee arthroplasties, reducing the bleeding and blood transfusion necessary to the treatment of posthaemorrhagic anemia. This paper wants to assess the efficiency of the tranexamic acid in realization of hemostasis to another category of patients, haemophiliac patients with indication of total hip and knee endoprosthesis.