BACKGROUND: The purpose of this study is to perform a meta-analysis to compare outcomes of venous thromboembolism (VTE) prophylaxis with low-molecular-weight heparin (LMWH) vs other anticoagulants in patients who received total knee (TKA) or total hip arthroplasty (THA).
METHODS: MEDLINE, Cochrane, EMBASE, and Google Scholar databases were searched until June 30, 2017 for eligible randomized controlled studies.
RESULTS: Thirty-two randomized controlled studies were included. LMWH provided better protection against VTE than placebo. In both TKA and THA patients, the rates of VTE were lower with factor Xa inhibitors than LMWH. In THA patients, the rate of deep vein thrombosis (DVT) was lower with factor Xa inhibitors than LMWH. In TKA patients, the rates of VTE and DVT were similar between LMWH and direct thrombin inhibitors. In THA patients, the rate of VTE was lower with direct thrombin inhibitors than with LMWH, while the DVT rates were similar. The pulmonary embolism rates were similar between all 3 classes of drugs in TKA and THR patients, as were the major bleeding rates. Nonmajor and minor bleeding rates were also similar between the 3 drug classes.
CONCLUSION: LMWH is associated with a higher rate of VTE than factor Xa inhibitors in TKA and THA patients. Direct thrombin inhibitors are associated with a lower rate of VTE in THA patients, but their effectiveness with respect to DVT and pulmonary embolism prophylaxis is similar to that of LMWH in TKA and THA patients.
BACKGROUND: Patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) are at risk of venous thromboembolism (VTE). Australian orthopaedic guidelines recommend aspirin and low-molecular-weight heparin (e.g. enoxaparin) for VTE prophylaxis; however, there is debate in the international literature around the use of aspirin as VTE prophylaxis. This review assesses the risks and benefits of aspirin compared to enoxaparin as VTE prophylaxis for patients undergoing THA or TKA.
METHODS: A systematic review was conducted to identify relevant randomized controlled trials. Studies comparing enoxaparin, aspirin and/or placebo for VTE prophylaxis in THA or TKA patients were included. Network meta-analysis (NMA) was performed to calculate risk ratios (RRs) and confidence intervals (CIs). Quality appraisal was conducted by assessing risk of bias and the strength of the evidence.
RESULTS: Nine randomized controlled trials were eligible for inclusion. The NMA found no statistically significant differences for the investigated outcomes: total DVT rates (RR = 1.21, 95% CI 0.86, 1.72), symptomatic pulmonary embolism (PE) rates (RR = 1.02, 95% CI 0.02, 50.86), major haemorrhage (RR = 0.97, 95% CI 0.02, 50.99) and wound complication (RR = 0.73, 95% CI 0.17, 3.20). The occurrence of PE was rare. Due to limited data, sub-group analysis was not possible. The overall quality of evidence in the NMA is considered to be very low.
CONCLUSION: This review did not find statistically significant differences between aspirin and enoxaparin. Future studies should identify more evidence, particularly for rare outcomes such as PE, as this might help decision-makers to get consensus on the use of aspirin as VTE prophylaxis.
OBJECTIVES: To assess the efficacy and safety of venous thromboembolism prophylaxis in people undergoing elective total hip replacement.
METHODS: Systematic review and Bayesian network meta-analyses of randomized controlled trials were conducted for 3 outcomes: deep vein thrombosis (DVT), pulmonary embolism (PE), and major bleeding (MB). MEDLINE, EMBASE, and Cochrane Library (CENTRAL) databases were searched. Study quality was assessed using the Cochrane risk-of-bias checklist. Fixed- and random-effects models were fitted and compared. The median relative risk (RR) and odds ratio (OR) compared with no prophylaxis, with their 95% credible intervals (CrIs), rank, and probability of being the best, were calculated.
RESULTS: Forty-two (n = 24 374, 26 interventions), 30 (n = 28 842, 23 interventions), and 24 (n = 31 792, 15 interventions) randomized controlled trials were included in the DVT, PE, and MB networks, respectively. Rivaroxaban had the highest probability of being the most effective intervention for DVT (RR 0.06 [95% CrI 0.01-0.29]). Strategy of low-molecular-weight heparin followed by aspirin had the highest probability of reducing the risk of PE and MB (RR 0.0011 [95% CrI 0.00-0.096] and OR 0.37 [95% CrI 0.00-26.96], respectively). The ranking of efficacy estimates across the 3 networks, particularly PE and MB, had very wide CrIs, indicating high degree of uncertainty.
CONCLUSIONS: A strategy of low-molecular-weight heparin given for 10 days followed by aspirin for 28 days had the best benefit-risk balance, with the highest probability of being the best on the basis of the results of the PE and MB network meta-analyses. Nevertheless, there is considerable uncertainty around the median ranks of the interventions.
ESSENTIALS: Despite trial data, guidelines have not endorsed direct oral Xa inhibitors above other options. We provide profiles of venous thromboembolism and hemorrhage risk for 12 options. Direct oral Xa inhibitors had a favorable profile compared with low-molecular-weight heparin. Other options did not have favorable profiles compared with low-molecular-weight heparin.
SUMMARY:
BACKGROUND: There are numerous trials and several meta-analyses comparing venous thromboembolism (VTE) prophylaxis options after total hip and knee replacement (THR and TKR). None have included simultaneous comparison of new with older options. Objective To measure simultaneously the relative risk of VTE and hemorrhage for 12 prophylaxis options. METHODS: We abstracted VTE and hemorrhage information from randomized controlled trials published between January 1990 and June 2016 comparing 12 prophylaxis options. We then constructed networks to compute the relative risk for each option, relative to once-daily dosing with low-molecular-weight heparin (LMWH) Low. RESULTS MAIN: Relative to LMWH Low, direct oral Xa inhibitors had the lowest risk of total deep vein thrombosis (DVT)-asymptomatic and symptomatic- (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.35-0.57), translating to 53-139 fewer DVTs per 1000 patients. Vitamin K antagonists (VKAs) titrated to International Normalized Ratio [INR] 2-3 predicted 56% more DVT events (OR, 1.56; 95% CI, 1.14-2.14). Aspirin performed similarly (OR, 0.80; 95% CI, 0.34-1.86), although small numbers prohibit firm conclusions. Direct oral Xa inhibitors did not lead to significantly more bleeding (OR, 1.21; 95% CI, 0.79-1.90). Secondary: Relative to LMWH Low, direct oral Xa inhibitors prevented 4-fold more symptomatic DVTs (OR, 0.25; 95% CI, 0.13-0.47). CONCLUSIONS: Relative to LMWH Low, direct oral Xa inhibitors had a more favorable profile of VTE and hemorrhage risk, whereas VKAs had a less favorable profile. The profile of other agents was not more or less favorable. Clinicians should consider these profiles when selecting prophylaxis options.
BACKGROUND: Venous thromboembolism causes significant morbidity and mortality in patients after total joint arthroplasty. Although network meta-analyses have demonstrated a benefit of various thromboprophylactic agents, there remains a concern in the surgical community regarding the resulting wound complications. There is currently no systematic review of the surgical site bleeding complications of thromboprophylactic agents. The aim of this study was to systematically review the surgical site bleeding outcomes of venous thromboembolism prophylaxis in this population.
METHODS: A systematic review and meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials comparing more than one of low-molecular-weight heparin (LMWH), warfarin, rivaroxaban, apixaban, dabigatran, aspirin, or no pharmacologic treatment in patients after total hip or knee arthroplasty were selected for inclusion. Five meta-analyses were performed to compare LMWH with control, warfarin, apixaban, rivaroxaban, and dabigatran.
RESULTS: Forty-five randomized controlled trials of 56,730 patients were included. LMWH had a significantly increased relative risk of surgical site bleeding in comparison with control (relative risk, 2.32; 95% confidence interval, 1.40-3.85) and warfarin (1.54; 1.23-1.94). The relative risk of LMWH trended higher than apixaban (1.27; 1.00-1.63) and was similar to rivaroxaban (0.95; 0.74-1.23). Only 1 study reported the risk of surgical site bleeding in LMWH vs dabigatran (5.97; 2.08-17.11).
CONCLUSION: LMWH increased the risk of surgical site bleeding compared with control, warfarin. and dabigatran and trended toward an increased risk compared with apixaban. The risk of surgical site bleeding was similar with LMWH and rivaroxaban.
BACKGROUND: Major orthopedic surgeries, such as total knee replacement (TKR), total hip replacement (THR), and hip fracture (HFx) surgery, carry a high risk for venous thromboembolism (VTE)—deep vein thrombosis (DVT) and pulmonary embolism (PE).
METHODS: Updating a 2012 review, we compare interventions to prevent VTE after TKR, THR, and HFx surgery. We searched four databases and other sources through June 3, 2016, for randomized controlled trials (RCTs) and large nonrandomized comparative studies (NRCSs) reporting postoperative VTE, major bleeding, and other adverse events. We conducted pairwise meta-analyses, Bayesian network meta-analyses, and strength of evidence (SoE) synthesis.
RESULTS: Overall, 127 RCTs and 15 NRCSs met criteria. For THR: low molecular weight heparin (LMWH) has lower risk than unfractionated heparin (UFH) of various VTE outcomes (moderate to high SoE) and major bleeding (moderate SoE). LMWH and aspirin have similar risks of total PE, symptomatic DVT, and major bleeding (low SoE). LMWH has less major bleeding (low SoE) than direct thrombin inhibitors (DTI), but DTI has lower DVT risks (moderate SoE). LMWH has less major bleeding than vitamin K antagonists (VKA) (high SoE). LMWH and factor Xa inhibitor (FXaI) comparisons are inconsistent across VTE outcomes, but LMWH has less major bleeding (high SoE). VKA has lower proximal DVT risk than mechanical devices (high SoE). Longer duration LMWH has lower risk of various VTE outcome risks (low to high SoE). Higher dose LMWH has lower total DVT risk (low SoE) but more major bleeding (moderate SoE). Higher dose FXaI has lower total VTE risk (low SoE). For TKR: LMWH has lower DVT risks than VKA (low to high SoE), but VKA has less major bleeding (low SoE). FXaI has lower risk than LMWH of various VTE outcomes (low to moderate SoE), but LMWH has less major bleeding (low SoE) and more study-defined serious adverse events (low SoE). Higher dose DTI has lower DVT risk (moderate to high SoE) but more major bleeding (low SoE). Higher dose FXaI has lower risk of various VTE outcomes (low to moderate SoE). For HFx surgery: LMWH has lower total DVT risk than FXaI (moderate SoE).
CONCLUSIONS: VTE prophylaxis after major orthopedic surgery trades off lowered VTE risk with possible adverse events—in particular, for most interventions, major bleeding. In THR, LMWH has lower VTE and adverse event risks than UFH, LMWH and aspirin have similar risks of VTE and major bleeding, DTI has lower DVT risk than LMWH but higher major bleeding risk, and higher dose LMWH has lower DVT risk but higher major bleeding risk than lower dose. In TKR, VKA has higher DVT risk than LMWH but lower major bleeding risk, and higher dose DTI has lower DVT risk but higher major bleeding risk than lower dose. In HFx surgery and for other intervention comparisons, there is insufficient evidence to assess both benefits and harms, or findings are inconsistent. Importantly, though, most studies evaluate “total DVT” (an outcome of unclear clinical significance since it includes asymptomatic and other low-risk DVTs), but relatively few studies evaluate PE and other clinically important outcomes. This limitation yields a high likelihood of selective outcome reporting bias. There is also relatively sparse evidence on interventions other than LMWH.
BACKGROUND: Risk factors for venous thromboembolism (VTE) of total joint arthroplasty (TJA) have been examined by many studies. A comprehensive systematic review of recent findings of high evidence level in this topic is needed.
METHODS: We conducted a PubMed search for papers published between 2003 and 2013 that provided level-I and level-II evidences on risk factors for VTE of TJA. For each potential factors examined in at least three papers, we summarize the the number of the papers and confirmed the direction of statistically significant associations, e.g. "risk factor" "protective factor" or "controversial factor".
RESULTS: Fifty-four papers were included in the systematic review. Risk factors found to be associated with VTE of both total hip arthroplasty and total knee arthroplasty included older age, female sex, higher BMI, bilateral surgery, surgery time > 2 hours. VTE history was found as a VTE risk factor of THA but an controversial factor of TKA. Cemented fixation as compared to cementless fixation was found as a risk factor for VTE only of TKA. TKA surgery itself was confirmed as a VTE risk factor compared with THA surgery.
CONCLUSIONS: This systematic review of high level evidences published in recent ten years identified a range of potential factors associated with VTE risk of total joint arthroplasty. These results can provide informations in this topic for doctors, patients and researchers.
CONTEXTE: Alors que la littérature occidentale a surtout rapporté l'incidence de la thrombose veineuse profonde (TVP) et l'embolie pulmonaire (EP) après PTG avec la chimioprophylaxie, la littérature asiatique encore a surtout rapporté l'incidence sans chimioprophylaxie. Cela peut s'expliquer par une faible incidence de TVP et EP chez les patients asiatiques, bien que certaines études récentes suggèrent l'incidence après PTG chez les patients asiatiques est en augmentation. En outre, il est difficile de savoir si l'incidence des TVP et EP après PTG est aussi faible entre les différents pays d'Asie.
QUESTIONS / OBJECTIFS: Nous avons donc déterminé l'incidence globale des symptômes EP et TVP sans chimioprophylaxie après TKA dans la population asiatique, déterminer si l'incidence a tendance à augmenter au fil du temps en Asie, et a comparé l'incidence de l'EP symptomatique et TVP entre les pays asiatiques grâce à une méta-analyse.
MÉTHODES: Nous avons cherché le PubMed, Embase, Cochrane Library, Web of Science, et sites Google Scholar pour les études prospectives publiées entre 1996 et 2011. Un total de 1947 patients provenant de 18 études ont été examinées pour la méta-analyse.
Résultats: L'incidence des EP symptomatique était de 0,01%. L'incidence des TVP globale, TVP proximale, et DVT symptomatique étaient 40,4%, 5,8% et 1,9%, respectivement. Nous n'avons trouvé aucune différence dans l'incidence de l'EP symptomatique entre les pays asiatiques et aucun tendances dans les changements de l'incidence au fil du temps.
CONCLUSIONS: L'incidence de l'EP symptomatique et TVP après TKA sans prophylaxie est faible dans les pays asiatiques et n'a pas changé au fil du temps, en dépit des modes de vie occidentalisation et une population vieillissante. Une enquête plus approfondie avec les grandes études randomisées sont nécessaires pour confirmer nos conclusions et d'identifier les facteurs de risque prédisposant à la thrombose veineuse profonde.
CONTEXTE: La controverse persiste quant à savoir si tous les veaux veine thrombus doit être traité avec anticoagulation ou observé avec surveillance en duplex. Nous avons effectué une revue systématique de la littérature pour évaluer si les données pourraient soutenir soit l'approche, suivie par l'examen de son histoire naturelle en stratifiant résultats selon début propagation de caillots, d'embolie pulmonaire (PE), la récidive, et le syndrome post-thrombotique (PTS).
METHODES: Les essais Un total de 1513 articles ont été examinés qui ont été publiés à partir de Janvier 1975 à Août 2010 en utilisant les recherches de bases de données informatisées de PubMed, Cochrane Controlled Registre, et de nombreuses références croisées. Les études de langue anglaise examinant spécifiquement veau thrombose veineuse profonde (C-DVT) définie comme axiale et / ou veines musculaires du mollet, ne comportant pas la veine poplitée, ont été inclus. Des communications ont été examinées de façon indépendante par deux chercheurs (EM, FL) et la qualité classés sur la base de neuf normes méthodologiques des rapports sur quatre paramètres de résultats.
Résultats: Sur les 1513 citations examinés, 31 documents pertinents répondant à des critères prédéfinis ont été trouvés: six essais contrôlés randomisés (ECR) et 25 études de cohorte observationnelles ou séries de cas. Il y avait un RCT unique comparant directement anticoagulation sans anticoagulation avec la compression et la surveillance duplex, et ils ont trouvé aucune différence dans la propagation, PE, ou des saignements dans une population à faible risque. Sur la base de deux études de méthodologie modérément forte, la propagation C-TVP a été réduit avec anticoagulation. Lorsque le traitement est non affecté, la preuve modérément forte a suggéré que 15% se propagent à la veine poplitée ou plus. Cependant, sur la base des données non randomisées, mais modérée à haute qualité (niveau A et B des études), la propagation à poplitée ou plus était de 8% chez ceux sans anticoagulation traités avec surveillance seulement. Propagation impliquant veines du mollet adjacentes tout en restant dans le mollet est survenue dans un maximum de la moitié de tous ceux qui propagent. Les saignements majeurs était un point final destiné à trois ECR et a été rapporté comme 0% à 6%, avec une tendance vers un risque de saignement plus faible dans des études plus récentes. PE lors de la surveillance dans les études avec un traitement non affecté était remarquablement plus faible que les rapports historiques de PE enregistrées lors de la présentation, en insistant sur la distinction qui doit être faite entre les deux entités. Récurrence en C-DVT est inférieure à la cuisse DVT, et les données suggèrent que les groupes à faible risque avec des facteurs de risque transitoires, 6 semaines d'anticoagulation peut être suffisant, par opposition à 12 semaines. Les études de PTS rapporté que les patients avec C-TVP avaient moins de symptômes que leurs homologues de la cuisse DVT. Environ un sur 10 ont montré des symptômes de la classe CEAP 4 à 6; cependant, C5 ou C6 avec ulcération cicatrisée ou actifs ne sont pas couramment rencontrées.
CONCLUSIONS: Aucune étude de la méthodologie forte n'a pu être trouvée pour résoudre la controverse de traitement optimal de C-DVT. Compte tenu des risques de propagation, PE, et la récurrence, l'option de ne rien faire doit être considéré comme inacceptable. En l'absence de preuves solides pour soutenir anticoagulation sur la surveillance de l'imagerie avec anticoagulation sélective, soit la méthode de gestion de veau DVT doit rester comme des normes acceptables actuelles.
OBJECTIVES: This is an evidence report prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center (EPC) examining the comparative efficacy and safety of prophylaxis for venous thromboembolism in major orthopedic surgery (total hip replacement [THR], total knee replacement [TKR], and hip fracture surgery [HFS]) and other nonmajor orthopedic surgeries (knee arthroscopy, injuries distal to the hip requiring surgery, and elective spine surgery).
DATA SOURCES: Medline, the Cochrane Central Register of Controlled Trials, and Scopus from 1980 to May 2011 with no language restrictions.
REVIEW METHODS: Controlled trials of any size and controlled observational studies with ≥750 subjects were included in our comparative effectiveness review if they were in patients undergoing one of six a priori defined orthopedic surgeries; provided data on prespecified intermediate, final health, or harms outcomes; defined deep vein thrombosis (DVT) and pulmonary embolism (PE) according to rigorous criteria (where applicable), and included prophylactic products (pharmacologic or mechanical) available in the United States. Using predefined criteria, data on study design, interventions, quality criteria, study population, baseline characteristics, and outcomes were extracted. All of the available data were qualitatively evaluated and where possible, statistically pooled. We used random effects derived relative risks (RR) for most analyses and Peto's Odds Ratios (OR) in comparisons of rare events both with 95 percent confidence intervals (CIs). I(2) was used to detect statistical heterogeneity and Egger's weighted regression statistics were used to assess for publication bias. The strength of evidence (SOE) and applicability of evidence (AOE) for each outcome was rated as insufficient (I), low (L), moderate (M), or high (H).
RESULTS: In major orthopedic surgery (THR, TKR, and HFS, respectively), the incidence of DVT (39 percent, 53 percent, 47 percent), PE (6 percent, 1 percent, 3 percent), major bleeding (1 percent, 3 percent, 8 percent), and minor bleeding (5 percent, 5 percent, not reported) were reported in the placebo/control groups of clinical trials. The SOE and AOE were predominantly low for THR and TKR and was insufficient HFS. In major orthopedic surgery, pharmacologic prophylaxis reduced major venous thromboembolism (VTE) (OR 0.21 [0.05 to 0.95], SOE.: L, AOE.: L), DVT (RR 0.56 [0.47 to 0.68], SOE.: M, AOE.: L), and proximal DVT (pDVT) (RR 0.53 [0.39 to 0.74], SOE.: H, AOE.: L), but increased minor bleeding (RR 1.67 [1.18 to 2.38], SOE.: H, AOE.: M). Prolonged prophylaxis for ≥28 days was superior to prophylaxis for 7 to 10 at reducing symptomatic objectively confirmed VTE (RR 0.38 [0.19 to 0.77], SOE.: M, AOE.: L), PE (OR 0.13 [0.04 to 0.47], SOE.: H, AOE.: L), DVT (RR 0.37 [0.21 to 0.64], SOE.: M, AOE.: M), and pDVT (RR 0.29 [0.16 to 0.52], SOE.: H, AOE.: M) but increased minor bleeding (OR 2.44 [1.41 to 4.20], SOE.: H, AOE.: M). Using both pharmacologic and mechanical prophylaxis reduced DVT (RR 0.48 [0.32 to 0.72] SOE.: M, AOE.: M) versus pharmacologic prophylaxis alone. Low molecular weight heparins (LMWHs) reduced PE (OR 0.48 [0.24 to 0.95], SOE.: M, AOE.: L), DVT (RR 0.80 [0.65 to 0.99], SOE.: M, AOE.: L), pDVT (RR 0.60 [0.38 to 0.93], SOE.: H, AOE.: L), major bleeding (OR 0.57 [0.37 to 0.88], SOE.: H, AOE.: L), and heparin induced thrombocytopenia (OR 0.12 [0.03 to 0.43], SOE.: M, AOE.: L) versus unfractionated heparin. LMWHs reduced DVT (RR 0.66 [0.55 to 0.79], SOE.: L, AOE.: M) but increased major bleeding (RR 1.92 [1.27 to 2.91], SOE.: H, AOE.: M), minor bleeding (RR 1.23 [1.06 to 1.43], SOE.: M, AOE.: M), and surgical site bleeding (OR 2.63 [1.31 to 5.28], SOE.: L, AOE.: L) versus vitamin K antagonists. LMWHs increased DVT (RR 1.99 [1.57 to 2.51], SOE.: M, AOE.: L) and pDVT (OR 2.19 [1.52 to 3.16], SOE.: L, AOE.: L) but reduced major bleeding (OR 0.65 [0.48 to 0.89], SOE.: M, AOE.: L) versus factor Xa inhibitors. Antiplatelets increased DVT (1.63 [1.11 to 2.39], SOE.: M, AOE.: L) versus mechanical prophylaxis. Unfractionated heparin increased DVT (RR 2.31 [1.34 to 4.00], SOE.: M, AOE.: L) and pDVT (OR 4.74 [2.99 to 7.49], SOE.: M, AOE.: L) versus direct thrombin inhibitors. Intermittent compression stocking decreased DVT (RR 0.06 [0.01 to 0.41], SOE.: L, AOE.: L) versus graduated compression stockings. We did not have adequate information to evaluate the role of inferior vena cava filter (IVC) filters or to evaluate the impact of prophylaxis on nonmajor orthopedic surgeries.
CONCLUSIONS: In major orthopedic surgery, while the risk of developing deep vein thrombosis is highest followed by pulmonary embolism and major bleeding, there are inadequate data to say whether or not deep vein thrombosis causes pulmonary embolism or is an independent predictor of pulmonary embolism. The balance of benefits to harms is favorable for providing prophylaxis to these patients and to extend the period of prophylaxis beyond the standard 7–10 days. The comparative balance of benefits to harms for LMWHs are superior to unfractionated heparin. Other interclass comparisons either could not be made due to lack of data, showed similarities between classes on outcomes, or had offsetting effects where benefits of one class on efficacy was tempered by an increased risk of bleeding. The balance of benefits to harms for combined pharmacologic plus mechanical prophylaxis versus either strategy alone could not be determined. We could not determine the impact of IVC filters on outcomes or the impact of prophylaxis on the nonmajor orthopedic surgeries evaluated.
The purpose of this study is to perform a meta-analysis to compare outcomes of venous thromboembolism (VTE) prophylaxis with low-molecular-weight heparin (LMWH) vs other anticoagulants in patients who received total knee (TKA) or total hip arthroplasty (THA).
METHODS:
MEDLINE, Cochrane, EMBASE, and Google Scholar databases were searched until June 30, 2017 for eligible randomized controlled studies.
RESULTS:
Thirty-two randomized controlled studies were included. LMWH provided better protection against VTE than placebo. In both TKA and THA patients, the rates of VTE were lower with factor Xa inhibitors than LMWH. In THA patients, the rate of deep vein thrombosis (DVT) was lower with factor Xa inhibitors than LMWH. In TKA patients, the rates of VTE and DVT were similar between LMWH and direct thrombin inhibitors. In THA patients, the rate of VTE was lower with direct thrombin inhibitors than with LMWH, while the DVT rates were similar. The pulmonary embolism rates were similar between all 3 classes of drugs in TKA and THR patients, as were the major bleeding rates. Nonmajor and minor bleeding rates were also similar between the 3 drug classes.
CONCLUSION:
LMWH is associated with a higher rate of VTE than factor Xa inhibitors in TKA and THA patients. Direct thrombin inhibitors are associated with a lower rate of VTE in THA patients, but their effectiveness with respect to DVT and pulmonary embolism prophylaxis is similar to that of LMWH in TKA and THA patients.
