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Venous Thromboembolism Prophylaxis in Orthopedic Surgery

Slide: 17 of 30

Comparative Effectiveness of Pharmacological Prophylaxis Agents: LMWH Versus Warfarin

Injectable LMWH had significantly fewer DVT events versus warfarin [RR 0.66 (95% CI 0.55 to 0.79)].

  • LMWH had significantly fewer DVT events versus warfarin in trials of conducted from 2001 to the present and in THR and TKR surgeries.

Injectable LMWH had significantly fewer asymptomatic DVT events versus warfarin.

  • The same results occurred in trials published from 2001 to the present and in TKR surgery.

Injectable LMWH did not significantly impact the risk of proximal DVT versus warfarin with borderline significance [RR 0.63 (95% CI 0.37 to 1.00)].

Injectable LMWH had significantly fewer distal DVT events versus warfarin [RR 0.56 (95% CI 0.43 to 0.73)].

  • Injectable LMWH had significantly fewer distal DVT events versus warfarin in THR and TKR surgeries.

Injectable LMWH had significantly more major bleeding than warfarin [OR 1.92 (95% CI 1.27 to 2.91)].

  • Injectable LMWH had significantly more major bleeding than warfarin in THR and TKR surgeries.

Injectable LMWH had significantly more minor bleeding than warfarin [RR 1.23 (95% CI 1.06 to 1.43)].

Injectable LMWH had significantly more surgical site bleeding than warfarin [OR 2.63 (95% CI 1.31 to 5.28)].

  • Injectable LMWH had significantly more surgical site bleeding than warfarin in THR surgery.
  • When major surgical site bleeding was evaluated separately, injectable LMWH had significantly more major surgical site bleeding than warfarin.

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