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Venous Thromboembolism Prophylaxis in Orthopedic Surgery

Slide: 14 of 30

Comparative Effectiveness of Pharmacological and Mechanical Prophylaxis Agents

The results on the comparative effectiveness of pharmacological prophylaxis agents is taken from the comparative effectiveness review titled Venous Thromboembolism Prophylaxis in Orthopedic Surgery. Classes of interventions included oral antiplatelet agents, injectable low-molecular-weight heparins, injectable unfractionated heparin, injectable or oral factor Xa inhibitors, injectable or oral direct thrombin inhibitors, oral vitamin K antagonists, and mechanical interventions. Only studies that compared pharmacological or mechanical prophylaxis with placebo or a control without the use of off-protocol prophylaxis (with the exception of elastic stockings) were included. Forty-five randomized controlled trials (N = 36,152) and three controlled observational studies (N = 144,806) evaluated the comparative efficacy between classes of pharmacological prophylaxis and mechanical methods of prophylaxis on final health, intermediate, and adverse outcomes. Twenty-six trials exclusively enrolled patients who had total hip replacement surgery (N = 20,261), 11 trials enrolled patients who had total knee replacement surgery (N = 8,185), 4 trials enrolled patients who had hip fracture surgery (N = 2,155), and 4 trials enrolled patients who had either total hip replacement surgery or total knee replacement surgery (N = 4,043). The earliest trial was published in 1987 and the most recent in 2011. The duration of followup ranged from the postoperative period to 180 days. The mean age of enrolled patients ranged from 52.4 years to 78.3 years. Females represented between 36.05 and 84.09 percent of the enrolled populations.