Short versus Long Venous Thromboembolism Prophylaxis Following Elective Total Hip Arthroplasty: A Bayesian Network...

Pharmacological venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA) lacks consensus regarding optimal duration. We conducted a network meta-analysis (NMA) to evaluate the efficacy and safety of commonly used prophylactic strategies.

This meta-analysis included studies up to April 2025 comparing short duration (10 to 14 days) and extended-duration (28 to 35 days) regimens of low molecular weight heparin, direct oral anticoagulants (DOACs), and aspirin after THA. Outcomes included symptomatic deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and 90-day mortality. The search yielded 1,733 records, of which 25 studies (n = 28,772; mean age 62 years; 54.3% women) were included.

Short-duration prophylaxis was associated with higher odds of symptomatic DVT (odds ratio (OR): 1.87 [1.19 to 2.94]; P = 0.006) and PE (1.80 [1.02 to 3.18]; P = 0.043) compared with extended-duration regimens, with no difference in bleeding or 90-day mortality. A sensitivity analysis excluding pre-2000 studies showed that the reduction in symptomatic DVT with extended-duration prophylaxis was less pronounced (OR: 1.79 [1.12 to 2.86]; P = 0.014), and the difference in PE was no longer significant. In the five-arm NMA, DOAC-long had the lowest DVT risk (OR 0.69 [0.42 to 1.14]), while low molecular weight heparin-short (OR: 1.97 [1.18 to 3.32]) and aspirin-long (OR: 1.81 [1.10 to 2.99]) significantly increased it. The DOAC-short had the lowest bleeding risk (OR: 0.71 [0.13 to 6.47]), but with high uncertainty. The PE and mortality differences were not significant.

Extended-duration prophylaxis was associated with reduced rates of symptomatic DVT and PE following THA. In the NMA, DOAC-long demonstrated the most favorable efficacy for reducing symptomatic DVT, with comparable results to DOAC-short, while DOAC-short had the lowest bleeding risk. Given evolving pathways that promote early mobilization, a contemporary trial is warranted to assess the net benefit of short-versus extended-duration prophylaxis.

Level II.