Venous Thromboembolism Prophylaxis in Orthopedic Surgery
Comparative Effectiveness of Pharmacological Prophylaxis Agents: Enoxaparin Versus Fondaparinux
Injectable LMWHs had significantly more DVT events versus injectable or oral factor Xa inhibitors [RR 1.99 (95% CI 1.57 to 2.51)].
- Injectable LMWHs had significantly more DVT events versus fondaparinux in THR, TKR, and hip fracture surgery.
While no significant differences were seen in the base case analysis, enoxaparin had significantly fewer symptomatic DVT events versus fondaparinux in THR surgery.
Enoxaparin had significantly more proximal DVT events than fondaparinux [OR 2.19 (95% CI 1.52 to 3.16)].
- Enoxaparin had significantly more proximal DVT events than fondaparinux in TKR surgery and hip fracture surgery with a trend in the same direction with THR surgery.
Although no difference was found in the base case analysis, enoxaparin had significantly fewer objectively confirmed symptomatic VTE events versus fondaparinux in patients who underwent total hip replacement.
Enoxaparin had significantly less major bleeding than fondaparinux [OR 0.65 (95% CI 0.48 to 0.89)].
- Enoxaparin had significantly less major bleeding than fondaparinux in THR and TKR surgeries.
- The different direction of effect between the THR and TKR surgery trials versus the hip fracture surgery trials likely explains the higher level of statistical heterogeneity in the base case analysis.
Enoxaparin had significantly less minor bleeding than fondaparinux [OR 0.57 (95% CI 0.35 to 0.94)].
- Enoxaparin had significantly less minor bleeding than fondaparinux in hip fracture 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; RR = relative risk; THR = total hip replacement; TKR = total knee replacement; VTE = venous thromboembolism
Keywords: bleeding | deep vein thrombosis | enoxaparin | fondaparinux | low-molecular-weight heparin | magnitude of effect | pharmacological prophylaxis | pulmonary embolism | strength of evidence | total hip replacement | total knee replacement | unfractionated heparin | venous thromboembolism | orthopedic surgery
- Sobieraj DM, Coleman CI, Tongbram V, et al. Venous Thromboembolism in Orthopedic Surgery. Comparative Effectiveness Review No. 49 (Prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center under Contract No. 290-2007-10067-I). Rockville, MD: Agency for Healthcare Research and Quality; March 2012. AHRQ Publication No. 12-EHC020-EF. Available at www.effectivehealthcare.ahrq.gov/thrombo.cfm.
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