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Venous Thromboembolism Prophylaxis in Orthopedic Surgery

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Comparative Effectiveness of Prolonged (=28 Days) Versus Standard (7–10 Days) Pharmacological Prophylaxis

Eight randomized controlled trials (N = 2,917) and no controlled observational studies evaluated the effect of prolonging prophylaxis for 28 days or longer when compared with prophylaxis for 7 to 10 days on final, intermediate, or adverse outcomes. Six trials (N = 1,388) exclusively enrolled patients who have had total hip replacement surgery. One trial (N = 873) enrolled patients who had either total hip replacement or total knee replacement surgery and reported the results separately for each surgical population. One trial (N = 656) enrolled patients who have had hip fracture surgery.

One trial (N = 656) evaluated the factor Xa inhibitor fondaparinux, one trial (N = 360) evaluated the vitamin K antagonist warfarin, and five trials (N = 1,636) evaluated injectable low-molecular-weight heparin agents including enoxaparin and dalteparin. One trial (N = 265) compared dalteparin prophylaxis for 7 days versus dalteparin prophylaxis for 35 days, but patients also received dextran and graduated compression stockings as part of the randomized prophylaxis regimen; therefore, this trial was not pooled with other trials and is evaluated separately. The earliest trial was published in 1997 and the most recent in 2003. The duration of followup ranged from 32 to 90 days. The mean age of enrolled patients ranged from 63.4 years to 79 years. Females represented between 38.2 and 73.6 percent of the enrolled populations.