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Venous Thromboembolism Prophylaxis in Orthopedic Surgery

Slide: 19 of 30

Comparative Effectiveness of Pharmacological and Mechanical Prophylaxis

Pharmacological Versus Mechanical Prophylaxis
Warfarin had significantly fewer proximal DVT events versus mechanical prophylaxis [RR 0.34 (95% CI 0.16 to 0.73); NNT 11 to 31]. The strength of evidence for this finding was moderate.

  • Warfarin had significantly fewer proximal DVT events versus mechanical prophylaxis in total hip replacement surgery.

 Aspirin had significantly more DVT events versus mechanical prophylaxis [RR 1.63 (95% CI 1.11 to 2.39)]. The strength of evidence for this finding was moderate.

  • Aspirin had significantly more DVT events versus mechanical prophylaxis in total knee replacement surgery.

Pharmacological Plus Mechanical Prophylaxis Versus Pharmacological Prophylaxis

Pharmacological plus mechanical prophylaxis versus pharmacological prophylaxis alone decreased the risk for DVT events [RR 0.48 (95% CI 0.32 to 0.72); NNT 3 to 67]. The strength of evidence for this finding was moderate.

Pharmacological plus mechanical versus pharmacological prophylaxis alone had similar results for pulmonary embolism, nonfatal pulmonary embolism, and proximal DVT. The strength of evidence for this finding was low.

Abbreviations: 95% CI = 95-percent confidence interval; DVT = deep vein thrombosis; NNT = number needed to treat (the calculated range); RR = relative risk