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Venous Thromboembolism Prophylaxis in Orthopedic Surgery

Slide: 21 of 30

Prolonged (=28 Days) Versus Standard (7–10 Days) Pharmacological Prophylaxis: Clinical Outcomes

In this analysis, prolonging prophylaxis for 28 days or longer was compared with prophylaxis for 7 to 10 days in patients who had major orthopedic surgery.

Key Points
Prolonged prophylaxis reduced the occurrence of symptomatic, objectively confirmed VTE versus shorter term prophylaxis [RR 0.38 (95% CI 0.19 to 0.77)]. While high heterogeneity was found, the direction of effect was consistent between all of the trials.

  • In subgroup analyses of trials conducted from 2001 to the present or of patients undergoing THR or hip fracture surgery, prolonged prophylaxis reduced the occurrence of symptomatic, objectively confirmed VTE versus shorter term prophylaxis.
  • In the one trial that stratified results based on gender, women with THR or TKR surgery had fewer symptomatic VTE events after prolonged prophylaxis as did men with THR surgery.

Prolonged prophylaxis reduced the occurrence of PE versus shorter term prophylaxis [OR 0.13 (95% CI 0.04 to 0.47)].

  • In subgroup analyses of trials conducted from 2001 to the present or of patients undergoing THR surgery, prolonged prophylaxis reduced the occurrence of PE versus shorter term prophylaxis.

Prolonged prophylaxis reduced the occurrence of nonfatal PE versus shorter term prophylaxis [OR 0.13 (95% CI 0.03 to 0.54)].

  • In subgroup analyses of trials of THR surgery, prolonged prophylaxis reduced the occurrence of nonfatal PE versus shorter term prophylaxis.

Prolonged prophylaxis reduced the occurrence of DVT versus shorter term prophylaxis [RR 0.37 (95% CI 0.21 to 0.64)]. While higher heterogeneity was found, the direction of effect was consistent between all of the trials.

  • In subgroup analyses of trials conducted from 2001 to the present or in patients undergoing THR or hip fracture surgery, prolonged prophylaxis reduced the occurrence of DVT versus shorter term prophylaxis.

 Prolonged prophylaxis reduced the occurrence of asymptomatic DVT versus shorter term prophylaxis [RR 0.48 (95% CI 0.31 to 0.75)].

  • In subgroup analyses of patients undergoing THR surgery, prolonged prophylaxis reduced the occurrence of DVT versus shorter term prophylaxis.

Prolonged prophylaxis reduced the occurrence of symptomatic DVT versus shorter term prophylaxis [OR 0.36 (95% CI 0.16 to 0.81)].

Prolonged prophylaxis reduced the occurrence of proximal DVT versus shorter term prophylaxis [RR 0.29 (0.16 to 0.52)].

  • In subgroup analyses of trials conducted from 2001 to the present or in patients undergoing THR or hip fracture surgery, prolonged prophylaxis reduced the occurrence of proximal DVT versus shorter term prophylaxis.

Abbreviations: 95% CI = 95-percent confidence interval; DVT = deep vein thrombosis; OR = odds ratio; PE = pulmonary embolism; RR = relative risk; THR = total hip replacement; TKR = total knee replacement; VTE = venous thromboembolism