What question did this study set out to answer?

To evaluate and compare the efficacy and safety of low-molecular-weight heparin, warfarin, aspirin, low-dose heparin, and pneumatic compression for venous thromboembolism prophylaxis in elective total hip arthroplasty.

July 1, 2000Journal of Bone and Joint Surgery

A Meta-Analysis of Thromboembolic Prophylaxis Following Elective Total Hip Arthroplasty*

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Why the study?

Do thromboembolic prophylaxis agents reduce the risk of deep venous thrombosis and pulmonary embolism in patients undergoing elective total hip arthroplasty?

Population

10,929 patients undergoing elective total hip arthroplasty across 52 randomized controlled trials. Inclusion…

Comparison

Thromboembolic prophylaxis agents vs Placebo or any other prophylactic agent

Design

Meta-analysis

Authors

KFKevin B. FreedmanRothman Institute KBKeith R. BrookenthalChildren's Hospital of Philadelphia RFRobert H. FitzgeraldUniversity of North Carolina at Chapel Hill

Discussion

Member takes

Implication

Supports routine prophylaxis to reduce DVT after elective THA; confirms efficacy versus placebo across agents.

Key Points

To evaluate and compare the efficacy and safety of low-molecular-weight heparin, warfarin, aspirin, low-dose heparin, and pneumatic compression for venous thromboembolism prophylaxis in elective total hip arthroplasty.
Conducted a systematic review and meta-analysis of 52 randomized controlled trials (N=10,929) published between January 1966 and May 1998 comparing prophylactic agents with placebo or active controls in elective total hip arthroplasty.
Required bilateral venography in all included studies to confirm or rule out deep venous thrombosis.
Calculated absolute event rates and 95% confidence intervals using a random-effects general linear model to evaluate deep venous thrombosis, pulmonary embolism, bleeding, and mortality.
Total deep venous thrombosis occurred in 48.5% of placebo patients compared to 17.7% to 31.1% across prophylaxis groups (p < 0.0001), with the lowest proximal thrombosis rates observed for warfarin (6.3%) and low-molecular-weight heparin (7.7%) versus placebo (25.8%, p < 0.0001).
Symptomatic pulmonary embolism risk was significantly reduced compared to placebo (1.51%) only by warfarin (0.16%), pneumatic compression (0.26%), and low-molecular-weight heparin (0.36%), with no significant differences observed in fatal pulmonary embolism or overall mortality across agents.
Minor wound bleeding was significantly higher with low-molecular-weight heparin (8.9%) and low-dose heparin (7.6%) than with placebo (2.2%, p < 0.05), whereas low-dose heparin alone caused significantly elevated rates of major wound bleeding (2.56% vs 0.28%, p < 0.0001).

Structured PICO

Do thromboembolic prophylaxis agents reduce the risk of deep venous thrombosis and pulmonary embolism in patients undergoing elective total hip arthroplasty?

Population

10,929 patients undergoing elective total hip arthroplasty across 52 randomized controlled trials. Inclusion required bilateral venography to confirm the presence or absence of deep venous thrombosis.

Intervention

Thromboembolic prophylaxis agents (low-molecular-weight heparin, warfarin, aspirin, low-dose heparin, or pneumatic compression)

Comparator

Placebo or any other prophylactic agent

Outcome

Rates of distal, proximal, and total (distal and proximal) deep venous thrombosishard clinical

Warfarin and pneumatic compression offer the best balance of efficacy and safety for thromboembolic prophylaxis following elective total hip arthroplasty, while low-dose heparin is the least effective and safe.

Cite This Study

Freedman et al. (2000) studied this question.

synapsesocial.com/papers/6a76339a67b8a7e54870827c https://doi.org/10.2106/00004623-200007000-00004

Topics

Pulmonary embolism Dual antiplatelet therapy Anticoagulation in AF

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A Meta-Analysis of Thromboembolic Prophylaxis Following Elective Total Hip Arthroplasty*

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

A Meta-Analysis of Thromboembolic Prophylaxis Following Elective Total Hip Arthroplasty*

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider