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Venous Thromboembolism Prophylaxis in Orthopedic Surgery

Slide: 15 of 30

Comparative Effectiveness of Pharmacological Prophylaxis Agents: LMWH Versus UFH

LMWH had significantly fewer DVT events versus UFH [RR 0.80 (95% CI 0.65 to 0.99)].

  • Injectable LMWH had significantly fewer DVT events versus injectable UFH in THR and TKR surgeries.
  • Injectable LMWH had significantly more DVT events versus injectable UFH in hip fracture surgery.
  • No differences in efficacy between injectable LMWH or UFH was seen based on age, gender, or African-American race; however, 30-mg enoxaparin, but not 40-mg enoxaparin, was superior to UFH in preventing DVT in whites.

Injectable LMWH had significantly fewer proximal DVT events versus injectable UFH [RR 0.60 (95% CI 0.38 to 0.93)] in THR and TKR surgeries.

Injectable LMWH had significantly fewer PE events versus injectable UFH [OR 0.48 (95% CI 0.24 to 0.95)].

  • Injectable LMWH had significantly fewer PE events versus injectable UFH in THR surgery; whereas, injectable LMWH had significantly higher PE events versus injectable UFH in hip fracture surgery.

Injectable LMWH had significantly less major bleeding than injectable UFH [OR 0.57 (95% CI 0.37 to 0.88)].

  • Injectable LMWH had significantly less major bleeding than injectable UFH in THR surgery.

Injectable LMWH had significantly less heparin-induced thrombocytopenia than injectable UFH [OR 0.12 (95% CI 0.03 to 0.43)].

  • Injectable LMWH had significantly less heparin-induced thrombocytopenia than injectable UFH in THR surgery.

Abbreviations: 95% CI = 95-percent confidence interval; DVT = deep vein thrombosis; LMWH = low-molecular-weight heparin; major bleeding = for example, bleeding leading to greater transfusion requirements and/or reoperation; minor bleeding = for example, surgical site bleeding, bleeding leading to infection, or bleeding leading to transfusion but not reoperation; OR = odds ratio; PE = pulmonary embolism; RR = relative risk; THR = total hip replacement; TKR = total knee replacement; UFH = unfractionated heparin