Thromboprophylaxis for orthopedic surgery; An updated meta-analysis

Area of Science:

• Orthopedic Surgery
• Pharmacology
• Thromboprophylaxis

Background:

• Venous thromboembolism (VTE) is a significant risk following orthopedic procedures.
• Low molecular weight heparin (LMWH) has been the standard VTE preventative treatment.
• Direct oral anticoagulants (DOACs) are emerging as alternatives for VTE prophylaxis.

Purpose of the Study:

• To compare the efficacy and safety of DOACs versus LMWH for preventing VTE in orthopedic surgery patients.
• To evaluate the rates of major VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality.
• To assess bleeding complications associated with DOACs and LMWH.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
• Searches were performed in major databases (MEDLINE, Embase, Cochrane) up to April 2020.
• Twenty-five RCTs involving 40,438 patients were included in the analysis.

Main Results:

• DOACs significantly reduced major VTE (composite of proximal DVT, PE, VTE mortality) and total DVT compared to LMWH.
• No significant difference was observed in the incidence of pulmonary embolism (PE) between DOACs and LMWH.
• Major bleeding, clinically relevant non-major bleeding, and all-cause mortality showed no statistically significant differences between the groups.

Conclusions:

• DOACs offer a significant reduction in major VTE and DVT for patients undergoing orthopedic surgery when compared to LMWH.
• The safety profile, including major bleeding events, was similar between DOACs and LMWH.
• DOACs represent an effective and safe alternative for thromboprophylaxis in this patient population.