This article was originally published here
Cureus. 2021 Nov 18;13(11):e19691. doi: 10.7759/cureus.19691. eCollection 2021 Nov.
Given the high risk of venous thromboembolism (VTE) after orthopedic surgery and the vital role of thromboprophylaxis in preventing VTE, this meta-analysis aimed to assess the effectiveness of thromboprophylaxis after major orthopedic surgery and measures of corresponding security. In this review, we performed a computer-assisted search of Google Scholar, PubMed, CINAHL, Cochrane, Medline and EMBASE databases. We included all published randomized clinical trials (RCTs) that used enoxaparin, fondaparinux, dabigatran, rivaroxaban, apixaban and aspirin for prophylaxis of VTE in patients undergoing total hip arthroplasty (ATH), hip fracture surgery and total knee arthroplasty (TKA) based on primary and secondary outcomes. The Cochrane Collaboration tool was used to assess risk of bias. All statistical analyzes were performed using Review Manager software. A total of 23 RCTs were included with a total sample size of 48,424 patients and an overall low risk of bias. The efficacy of enoxaparin in preventing VTE in the PTG group was significantly better than that of fondaparinux. In the PTH group, the efficacy of enoxaparin was significantly better than that of apixaban. The efficacy of fondaparinux, dabigatran, rivaroxaban, apixaban, and aspirin was comparable to that of enoxaparin in reducing VTE-associated mortality, major bleeding, and adverse events. In conclusion, we found that all included drugs were non-inferior to enoxaparin in VTE-associated mortality, major bleeding, and adverse events.