[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-448203-105":59,"doc-detail-448203-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","perioperative-management-of-total-hip-arthroplasty-in-hemophilia-a-following-gene-therapy-letter-to-the-editor","Perioperative management of total hip arthroplasty in hemophilia A following gene therapy - Letter to the editor","","Perioperative management is described for a 27-year-old man with severe hemophilia A who underwent total hip arthroplasty after AAV-mediated FVIII gene therapy. After treatment with GS1191-0445 in a clinical trial, FVIII:C declined from a peak 202.7 IU/dL toward ~60 IU/dL by week 56, prompting THA for end-stage arthropathy. Despite normal thromboelastography pre/intra-operatively, postoperative wound oozing required transfusion of fresh frozen plasma and leukocyte-reduced red blood cells. The report discusses balancing bleeding risk against the need for postoperative antithrombotic prophylaxis.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/perioperative-management-of-total-hip-arthroplasty-in-hemophilia-a-following-gene-therapy-letter-to-the-editor/448203/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/perioperative-management-of-total-hip-arthroplasty-in-hemophilia-a-following-gene-therapy-letter-to-the-editor/448203.png","ImageObject",300,407,{"name":92,"@type":93},"Theodore","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why was total hip arthroplasty scheduled after gene therapy in this patient?","Question",{"text":113,"@type":114},"THA was planned at week 56 due to end-stage hemophilic arthropathy of the hip after FVIII levels declined to a level consistent with surgery needs.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What monitoring data supported perioperative hemostatic assessment?",{"text":118,"@type":114},"FVIII expression was measured by one-stage clotting assay and additional FVIII:C assays, and thromboelastography parameters were normal pre-operatively and at the intra-operative assessment.",{"name":120,"@type":111,"acceptedAnswer":121},"What perioperative complications occurred and how were they managed?",{"text":122,"@type":114},"Continuous post-operative wound oozing occurred, leading to transfusion of fresh frozen plasma and leukocyte-reduced red blood cells despite normal pre/intra-operative TEG findings.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},448203,1790768080,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52,"preview_page_count":4},7971461740886,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","LETTER TO THE EDITOR  \nPerioperative management of total hip arthroplasty in hemophilia A following gene therapy  \nHemophilia A (HA) is an X-linked recessive bleeding disorder caused by pathologic genetic variants in the F8 gene, leading to deficient production of coagulation factor VIII (FVIII) .1 Patients with severe HA (defined as FVIII activity level \u003C1 IU/dL) typically experience recurrent spontaneous bleeding into soft tissues and joints, culminating in progressive hemophilic arthropathy characterized by chronic pain and irreversible joint mobility impairment.2,3 Adeno-associated virus (AAV)-mediated gene therapy has emerged as a promising treatment modality for severe HA, by enabling sustained therapeutic FVIII expression and effective control of hemorrhagic episodes.4,5 However, the therapeutic strategy demonstrates limited efficacy in reversing established hemophilic arthropathy, thereby ultimately requiring orthopedic interventions to restore optimal joint function in affected patients. This scenario also poses new challenges in maintaining hemostatic balance of these patients, which involves reconciling elevated hemostatic demands with potential anticoagulant needs.6-8 Here, we report the clinical course and treatment of a HA patient who had undergone total hip arthroplasty (THA) after receiving gene therapy. A 27-year-old man with severe HA was enrolled in a gene therapy clinical trial (clinicaltrials gov. Identifier: NCT04728841).9 The gene therapy product GS1191-0445, developed using an AAV8 vector platform integrated with a liver-specific expression cassette encoding B-domain-deleted FVIII, has been granted Breakthrough Therapy Designation (BTD) by China’s National Medical Products Administration (NMPA) Center for Drug Evaluation (CDE). This therapeutic candidate has successfully advanced into phase III clinical trial (clinicaltrials gov. Identifier: NCT06833983) following promising clinical outcomes. Clinical data from earlier stages demonstrated sustained therapeutic efficacy in subjects receiving the target dose of 3×10¹² vg/kg or higher, with endogenous FVIII activity levels (FVIII:C) consistently maintained above the threshold for effective bleeding control (≥5 IU/  \ndL) throughout the 12-month monitoring period. Compared to baseline, GS1191-0445 achieved a 99% reduction in annualized bleeding rate (unpublished data). After treatment with AAV-delivered FVIII, the expression level, as measured by one-stage clotting assay (OSA) using Dade Actin FSL activated partial thromboplastin time (APTT) reagent (Siemens), gradually declined from peak level of 202.7 IU/dL, to ∼ 60 IU/dL by week 56 (Figure 1A). At this time point, THA was scheduled due to end-stage hemophilic arthropathy of the hip. While antithrombotic prophylaxis (minimum 10-14 days starting ≥12 hours post-operatively) is a standard protocol for general THA patients,10,11 this recommendation presentsa clinical dilemma in hemophilic populations. The inherent thrombotic risk in arthroplasty patients must be carefully weighed against the amplified bleeding hazards associated with anticoagulant use in individuals with HA. Previously, Xue et al 12 have reported a case of successful unilateral total knee arthroplasty (TKA) without perioperative FIX supplementation following FIX-Padua gene transfer. In this case, given the dual clinical challenges of higher intraoperative blood loss and elevated postoperative venous thromboembolism (VTE) risks associated with THA compared to TKA,6,13 the optimal balance between intraoperative hemostatic management and postoperative antithrombotic prophylaxis remains clinically unsolved.  \nThis study was approved by the Ethics Committee of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine. The patient gave his informed consent to participate. Without supplement of FVIII prior to the surgical procedure, the patient experienced moderate intra-operative blood loss, estimated at 300 mL. Thromboelastograp","cbCaikKNnAGD7fEi","https://ap.wps.com/l/cbCaikKNnAGD7fEi","pdf",1434380,"English","# Patient course after gene therapy\n## FVIII:C monitoring and timing of surgery\n## Thromboelastography and perioperative blood management\n## Postoperative hemostatic challenges and prophylaxis dilemma","[{\"question\":\"Why was total hip arthroplasty scheduled after gene therapy in this patient?\",\"answer\":\"THA was planned at week 56 due to end-stage hemophilic arthropathy of the hip after FVIII levels declined to a level consistent with surgery needs.\"},{\"question\":\"What monitoring data supported perioperative hemostatic assessment?\",\"answer\":\"FVIII expression was measured by one-stage clotting assay and additional FVIII:C assays, and thromboelastography parameters were normal pre-operatively and at the intra-operative assessment.\"},{\"question\":\"What perioperative complications occurred and how were they managed?\",\"answer\":\"Continuous post-operative wound oozing occurred, leading to transfusion of fresh frozen plasma and leukocyte-reduced red blood cells despite normal pre/intra-operative TEG findings.\"}]","Perioperative management of total hip arthroplasty in hemophilia A following gene therapy - Letter to the editor | PDF",1790725980]