Abstract
BackgroundVenous thromboembolism (VTE) is an important complication following total hip replacement (THR) and total knee replacement (TKR) surgeries. Aim of this study was to comprehensively compare the clinical outcomes of low-molecular-weight heparin (LMWH) with other anticoagulants in patients who underwent TKR or THR surgery.MethodsMedline, Cochrane, EMBASE, and Google Scholar databases were searched for eligible randomized controlled studies (RCTs) published before June 30, 2017. Meta-analyses of odds ratios were performed along with subgroup and sensitivity analyses.ResultsTwenty-one RCTs were included. In comparison with placebo, LMWH treatment was associated with a lower risk of VTE and deep vein thrombosis (DVT) (P values < 0.001) but similar risk of pulmonary embolism (PE) (P = 0.227) in THR subjects. Compared to factor Xa inhibitors, LMWH treatment was associated with higher risk of VTE in TKR subjects (P < 0.001), and higher DVT risk (P < 0.001) but similar risk of PE and major bleeding in both THR and TKR. The risk of either VTE, DVT, PE, or major bleeding was similar between LMWH and direct thrombin inhibitors in both THR and TKR, but major bleeding was lower with LMWH in patients who underwent THR (P = 0.048).ConclusionIn comparison with factor Xa inhibitors, LMWH may have higher risk of VTE and DVT, whereas compared to direct thrombin inhibitors, LMWH may have lower risk of major bleeding after THR or TKR.
Highlights
Venous thromboembolism (VTE) is an important complication following total hip replacement (THR) and total knee replacement (TKR) surgeries
Characteristics of included studies The studies were divided into three subgroups based on the non-low-molecular-weight heparin (LMWH) treatment: Group I: LMWH vs. placebo (3 studies); Group II: LMWH vs. direct thrombin inhibitors (8 studies; 4 studies with ximelagatran and 4 with dabigatran etexilate); Group III: LMWH vs. factor Xa inhibitor (10 studies; 6 with studied rivaroxaban, 3 with apixaban, and 1 with darexaban)
The comparison of LMWH with placebo found that LMWH was associated with lower odds of VTE and deep vein thrombosis (DVT) compared to placebo in THR subjects, suggesting that prophylactic treatment of patients with LMWH could significantly reduce the rate of VTE and DVT but the incidence of pulmonary embolism (PE) was similar between the two groups
Summary
Venous thromboembolism (VTE) is an important complication following total hip replacement (THR) and total knee replacement (TKR) surgeries. Anticoagulants are routinely used and recommended after major orthopedic surgery to prevent VTE Anticoagulants has been found to reduce the risk of thromboembolic events by approximately 50% to 80% when prescribed prophylactically [1]. Both the American College of Chest Physicians (ACCP) and American Association of Orthopedic Surgeons (AAOS) guidelines for VTE prophylaxis recommend antithrombotic prophylaxis following THR or TKR [2, 4].
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