Mechanical vs. Pharmacological Thromboprophylaxis in High-Risk Surgical Cohorts: A Network Meta-Analysis of DVT Prevention and Bleeding Trade-offs

Abstract Background: We compared mechanical, pharmacological, and combined thromboprophylaxis strategies for preventing venous thromboembolism (VTE) in high-risk surgical patients using a Bayesian network meta-analysis. Objective: To compare the efficacy and safety of mechanical, pharmacological, and combined thromboprophylaxis methods in preventing venous thromboembolism (VTE) among high-risk surgical patients through a systematic review and Bayesian network meta-analysis. Methods: Ten randomized controlled trials (RCTs) and prospective cohort studies (n=12,286) were analyzed following PRISMA guidelines. Outcomes included incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and mortality. Bayesian network meta-analysis assessed treatment effectiveness and safety. Results: Combined prophylaxis showed the highest likelihood of preventing DVT (SUCRA: 0.92) and PE (SUCRA: 0.89). Pharmacological prophylaxis had moderate efficacy but significantly increased major bleeding risk (OR: 1.37, 95% CrI: 1.01–1.84). Mechanical prophylaxis alone had the safest profile regarding bleeding but lower effectiveness in VTE prevention. Conclusion: Combined prophylaxis optimizes VTE prevention but increases bleeding risks. Mechanical prophylaxis alone is safest for patients with high bleeding risk. Individualized, risk-based prophylaxis selection is recommended.