Abstract
Given the high risk of venous thromboembolism (VTE) post-orthopedic surgery and the vital role of thromboprophylaxis in preventing VTEs, this meta-analysis aimed to assess the efficacy of thromboprophylaxis post major orthopedic surgery and the relevant safety measures.In this review, we conducted a computer-aided search of Google Scholar, PubMed, CINAHL, Cochrane, Medline, and EMBASE databases. We included all published randomized clinical trials (RCTs) that utilized enoxaparin, fondaparinux, dabigatran, rivaroxaban, apixaban, and aspirin for VTE prophylaxis in patients undergoing total hip arthroplasty (THA), hip fracture surgery, and total knee arthroplasty (TKA) based on primary and secondary outcomes. The Cochrane Collaboration tool was used to evaluate the risk of bias. All statistical analyses were performed using Review Manager Software.A total of 23 RCTs were included with a total sample of 48,424 patients and an overall low risk of bias. The efficacy of enoxaparin in preventing VTEs in the TKA group was significantly better than fondaparinux. In the THA group, the efficacy of enoxaparin was significantly better than apixaban. The efficacies of fondaparinux, dabigatran, rivaroxaban, apixaban, and aspirin were comparable to that of enoxaparin in reducing VTE-associated mortality, major bleeding, and adverse events. In conclusion, we found that all included drugs were non-inferior to enoxaparin in VTE-associated mortality, major bleeding, and adverse events.
Highlights
Venous thromboembolism (VTE) is a general term that includes the formation of a deep vein thrombus (DVT) in the legs, pelvis, or arms, which can lead the thrombus to dislodge and travel to the lungs, producing a pulmonary embolism (PE) or a cerebrovascular event in patients with patent foramen ovale (PFO) [1]
There has been a rise in the frequency of major surgeries such as total hip arthroplasty (THA), pelvic fracture surgery (PFS), hip fracture surgery (HFS), and total knee arthroplasty (TKA) [6,7]
This study aims to investigate the efficacy and safety of thromboprophylaxis in orthopedic surgeries
Summary
BackgroundVenous thromboembolism (VTE) is a general term that includes the formation of a deep vein thrombus (DVT) in the legs, pelvis, or arms, which can lead the thrombus to dislodge and travel to the lungs, producing a pulmonary embolism (PE) or a cerebrovascular event in patients with patent foramen ovale (PFO) [1]. Risk factors associated with VTE include hereditary thrombophilia, obesity, oral contraceptive pills, fractures, and malignancy [4]. Another well-known risk factor for developing VTE is major surgeries, including orthopedic surgery, abdominal surgery, and pelvic surgery [5]. The incidence of fatal PE in patients using thromboprophylaxis has reduced from 3-7% to 0.1% in 90 days after surgery [9] The pathophysiology behind these procedures that makes the patients prone to VTE relies on several factors such as manipulating the extremity, the use of a tourniquet, immobilization, and the use of polymethylmethacrylate (PMMA) cement [6]. Managing the risk of VT among patients who undergo major orthopedic interventions is vital [10]
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