Key result
DOACs, LMWH, and warfarin remain effective for postoperative DVT management, with DOACs requiring less monitoring.
Why the study?
There remains controversy on the relative efficacy and toxicity of low molecular weight heparin, rivaroxaban, apixaban, and warfarin for postoperative thromboprophylaxis and deep vein thrombosis management.
Systematic Review
Supports selecting among these agents by monitoring burden in postoperative and DVT care; confirms established efficacy and DOAC advantages.
Prophylactic venous thrombosis or more commonly known as postoperative "blood clots" is a problem in all surgeries and is known as venous thromboembolism or VTE, and continues to be a significant cause of postoperative morbidity and mortality. For the prevention and treatment of a thromboembolic event, pharmacological anticoagulation is required, but there remains some controversy on the relative efficacy and toxicity of the numerous drugs that are used in this setting. The present systematic review and meta-analysis revisits the benefits of LMWH and the new TKIs – rivaroxaban, apixaban and warfarin – for postoperative thromboprophylaxis and treatment of DVT. They will conduct a literature search in Pubmed/MEDLINE, Embase, Scopus, Web of Science and Cochrane library following the PRISMA of 2020. Randomized controlled and comparative observational studies in the treatment of adults will be included. Postoperative deep vein thrombosis, recurrence of VTE, PEs, mortality, clinical non-major bleeding, and treatment complications will all be outcome measures of interest. But insofar as it is a proven option for anticoagulation, LMWH still has some current evidence that is useful, and insofar as it has been effective and useful for oral anticoagulation and is one of the new direct oral anticoagulants (as represented by rivaroxaban and apixaban), there is current evidence suggesting that both has oral bioavailability, and is not monitored as much. It is still clinically useful in the management of warfarin, although the dose needed for an individual does change slightly for all cases, and frequent monitoring of INR must be carried out.
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Furqan et al. (2026) conducted a systematic review in Postoperative venous thromboembolism and deep vein thrombosis. Low Molecular Weight Heparin, Rivaroxaban, Apixaban, and Warfarin was evaluated on Postoperative deep vein thrombosis, recurrence of VTE, pulmonary embolisms, mortality, clinical non-major bleeding, and treatment complications. LMWH, rivaroxaban, apixaban, and warfarin remain clinically useful for postoperative thromboprophylaxis and DVT management, with direct oral anticoagulants requiring less monitoring than warfarin.
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