March 30, 2016Cochrane libraryOpen Access

Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair

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Why the study?

Does extended-duration anticoagulant thromboprophylaxis reduce symptomatic VTE in people undergoing elective hip or knee replacement surgery?

Population

24,930 participants from 16 RCTs undergoing elective hip or knee replacement surgery.

Comparison

Extended-duration thromboprophylaxis using… vs Short-duration thromboprophylaxis followed by…

Design

Meta-analysis

Follow-up

five to seven weeks

Authors

RFRachel ForsterNorwegian Institute of Public Health MSMarlene StewartUniversity of Edinburgh

Discussion

Member takes

Implication

Supports extended-duration DOAC after hip/knee replacement; confirms VTE reduction versus placebo with minor bleeding trade-off.

Structured PICO

Does extended-duration anticoagulant thromboprophylaxis reduce symptomatic VTE in people undergoing elective hip or knee replacement surgery?

Population

24,930 participants from 16 RCTs undergoing elective hip or knee replacement surgery (no studies assessed hip fracture repair).

Intervention

Extended-duration thromboprophylaxis (five to seven weeks) using accepted prophylactic doses of low-molecular-weight heparin (LMWH), unfractionated heparin (UFH), vitamin K antagonists (VKA), or direct oral anticoagulants (DOAC).

Comparator

Short-duration thromboprophylaxis (seven to 14 days) followed by placebo, no treatment, or similar extended-duration thromboprophylaxis with LMWH, UFH, VKA, or DOACs.

Outcome

Symptomatic venous thromboembolism (VTE).hard clinical

Extended-duration anticoagulants, particularly DOACs, reduce symptomatic VTE after hip replacement surgery, though the benefit must be weighed against an increased risk of minor bleeding.

Limitations

Some comparisons included a single study
Low number of events
Heterogeneity between studies leading to wide confidence intervals
Insufficient reporting leading to unclear risk of bias in some trials

Cite This Study

Forster et al. (2016) studied this question.

synapsesocial.com/papers/6a7c080848312d37e475fd4a https://doi.org/10.1002/14651858.cd004179.pub2

Topics

Anticoagulation in AF

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Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Topics

Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider