Abstract
BackgroundPatients with hip fractures (HF) have an increased risk of venous thromboembolism (VTE). In elective orthopedic surgery direct oral anticoagulants (DOACs) have proven to be similarly or more effective compared to low molecular weight heparin (LMWH), but DOACs are not yet approved for thromboprophylaxis in trauma patients with HF. The aim of this study was to systematically review the literature comparing the effectiveness of DOACs and LMWH for thromboprophylaxis in trauma patients with surgically treated HF. Materials and MethodsWe searched PubMed, the Cochrane Library, Web of Science, and Embase. The primary outcome was the incidence of VTE (symptomatic and asymptomatic combined). Secondary outcomes were symptomatic VTE; a symptomatic VTE, symptomatic deep venous thrombosis (DVT); symptomatic pulmonary embolism (PE); major, clinically relevant non-major (CRNM), and minor bleeding. Meta-analysis was performed to compare the odds of VTE and secondary outcomes between DOACs and LMWH. ResultsThe search resulted in 738 titles. Five studies matched inclusion criteria. In total, 4748 hip fracture patients were analyzed (DOACs: 2276 patients, LMWH: 2472 patients). The pooled odds ratio for the risk of VTE for DOAC use was 0.52 (95% confidence interval 0.25–1.11, p = 0.09) compared to LMWH. No statistically significant differences between DOAC and LMWH were found for asymptomatic VTE, symptomatic DVT, PE, major or CRNM bleeding, and minor bleeding. ConclusionsMeta-analysis of the literature suggests that DOACs are associated with equivalent effectiveness and safety compared to LMWH.
Highlights
Venous thromboembolism (VTE), i.e. deep venous thrombosis (DVT) and pulmonary embolism (PE), is a potentially lethal, major public health concern
Considering the mortality and morbidity associated with venous thromboembolism (VTE), especially in elderly hip fracture patients, it is imperative to continually evaluate and improve thromboprophylaxis guidelines
Besides randomized controlled trials (RCT), non-randomized prospective and retrospective studies, as well as studies including both hip and other fractures were included considering the urgent demand for clinical evidence in the light of reported off-label prescription of direct oral anticoagulants (DOACs) to trauma patients, and considering the relative novelty of DOACs and an expected scarcity of literature on this topic
Summary
Venous thromboembolism (VTE), i.e. deep venous thrombosis (DVT) and pulmonary embolism (PE), is a potentially lethal, major public health concern. Considering the mortality and morbidity associated with VTE, especially in elderly hip fracture patients, it is imperative to continually evaluate and improve thromboprophylaxis guidelines. Patients with hip fractures (HF) have an increased risk of venous thromboembolism (VTE). In elective orthopedic surgery direct oral anticoagulants (DOACs) have proven to be or more effective compared to low molecular weight heparin (LMWH), but DOACs are not yet approved for thromboprophylaxis in trauma patients with HF. The aim of this study was to systematically review the literature comparing the effectiveness of DOACs and LMWH for thromboprophylaxis in trauma patients with surgically treated HF. Meta-analysis was performed to compare the odds of VTE and secondary outcomes between DOACs and LMWH. No statistically significant differences between DOAC and LMWH were found for asymptomatic VTE, symptomatic DVT, PE, major or CRNM bleeding, and minor bleeding.
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