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Venous Thromboembolism Prophylaxis in Orthopedic Surgery

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Baseline Postoperative Risk of Venous Thromboembolism and Bleeding Outcomes in Contemporary Practice

Eligible studies for this analysis included only patients undergoing major orthopedic surgery (total hip or total knee replacement or hip fracture surgery) or reported separate results for these major orthopedic surgeries; studies that compared pharmacological or mechanical methods of thromboprophylaxis with placebo or control without off-protocol use of pharmacological or mechanical methods of prophylaxis; and studies that reported data on at least one prespecified venous thromboembolic or bleeding outcome. The baseline postoperative risk of venous thromboembolic outcomes was estimated for each of the major orthopedic surgeries separately. Incidences for each outcome were extracted from placebo or control arms of trials and pooled for each major orthopedic surgery. If only one arm was available, the raw incidence of the outcome from the trial was reported. The same was done for bleeding outcomes, although arms that allowed the off-protocol use of elastic stockings were also included.

Nineteen randomized controlled trials (N = 1,325) and three controlled observational studies (N = 1,036) evaluated the overall baseline risk of venous thromboembolism outcomes and bleeding outcomes in contemporary practice. The mean age of enrolled patients ranged from 54.9 years to 80 years. Females represented between 18.0 to 91.81 percent of the enrolled populations. The mean weight ranged from 56 to 71.4 kilograms. Few enrolled patients had a history of venous thromboembolism, with the majority of trials reporting 0 to 10.0 percent. Presence of varicosity ranged from no varicosity to 33.3 percent. The percentage of patients with a history of malignancy ranged from 0 to 7.14 percent. None of the trials reported the percentage of patients who had previously undergone orthopedic surgery.