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Venous Thromboembolism Prophylaxis in Orthopedic Surgery

Slide: 22 of 30

Prolonged (=28 Days) Versus Standard (7–10 Days) Pharmacological Prophylaxis: Adverse Effects

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

Key Points
Prolonged prophylaxis increases the occurrence of minor bleeding versus shorter term prophylaxis [OR 2.44 (95% CI 1.44 to 4.20)].

  • In subgroup analyses of patients undergoing THR surgery, prolonged prophylaxis increases the occurrence of minor bleeding versus shorter term prophylaxis.

 Prolonged prophylaxis increases the occurrence of surgical site bleeding versus shorter term prophylaxis, although this was based on a single randomized controlled trial.

  • In subgroup analyses of trials conducted from 2001 to the present or of patients undergoing hip fracture surgery, prolonged prophylaxis increases the occurrence of surgical site bleeding versus shorter term prophylaxis.

While no significant difference was seen in the base case analysis, prolonged prophylaxis reduced the occurrence of hospital readmission versus shorter term prophylaxis in THR surgery.

Subgroup analyses of TKR surgery were based on a single comparison from one randomized controlled trial and did not show any statistically significant differences for the outcomes evaluated including symptomatic, objectively confirmed venous thromboembolism; pulmonary embolism and nonfatal pulmonary embolism; mortality due to bleeding; overall, proximal, and distal deep vein thrombosis; and major bleeding.

Abbreviations: 95% CI = 95-percent confidence interval; OR = odds ratio; THR = total hip replacement; TKR = total knee replacement