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NOACs for VTE prevention in patients with lower limb fracture: a systematic review and meta-analysis

Bingbing Wu1, Lili Sun1, Wenying Wu1

  • 1Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, 1th Shangcheng Avenue, Yiwu, Zhejiang Province, 322000, China.

Journal of Orthopaedic Surgery and Research
|July 15, 2025
PubMed
Abstract

Insights

Novel oral anticoagulants (NOACs) show a reduced risk of deep vein thrombosis (DVT) in patients with lower limb fractures compared to low molecular weight heparin (LMWH). However, no significant differences were found for overall venous thromboembolism (VTE), pulmonary embolism (PE), or major bleeding events.

Area of Science:

  • Orthopaedic Surgery
  • Pharmacology
  • Vascular Medicine

Background:

  • Novel oral anticoagulants (NOACs) are increasingly prescribed for patients undergoing orthopaedic surgery.
  • Venous thromboembolism (VTE) is a significant risk for patients with lower limb fractures.

Purpose of the Study:

  • To evaluate the efficacy and safety of NOACs in preventing VTE in patients with lower limb fractures.
  • To compare NOACs against low molecular weight heparin (LMWH) in this patient population.

Main Methods:

  • A meta-analysis of randomized controlled trials (RCTs) was conducted.
  • Literature search performed across PubMed, Embase, Cochrane Library, and Web of Science databases up to November 27, 2024.
  • Risk of bias assessed using Cochrane Risk of Bias Tool 2.0; data analyzed using RevMan 5.4.1.

Main Results:

  • Five RCTs with 4,092 participants were included.
  • NOACs significantly reduced the incidence of deep vein thrombosis (DVT) (OR=0.48, P=0.04).
  • No significant differences observed for VTE, pulmonary embolism (PE), or major bleeding events.

Conclusions:

  • NOACs demonstrate a potential benefit in reducing DVT risk for lower limb fracture patients.
  • Further research may be needed to confirm efficacy in preventing overall VTE and PE, and to fully assess safety profiles compared to LMWH.
Keywords:
Lower limb fracturesMeta-analysisNovel oral anticoagulantsVTE

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