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Curéus. 2021 November 18; 13 (11): e19691. doi: 10.7759 / cureus.19691. eCollection 2021 Nov.
Given the high risk of post-orthopedic venous thromboembolism (VTE) and the essential role of thromboprophylaxis in the prevention of VTE, this meta-analysis aimed to assess the efficacy of post-major orthopedic surgery thromboprophylaxis and measures of relevant 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 the prophylaxis of VTE in patients undergoing total hip replacement. (THA), hip fracture surgery and total knee replacement (TKA) based on primary and secondary outcomes. The Cochrane Collaboration tool was used to assess the risk of bias. All statistical analyzes were performed using Review Manager software. A total of 23 RCTs were included with a total sample 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 mortality associated with VTE, major bleeding and adverse events. In conclusion, we found that all of the included drugs were not inferior to enoxaparin in terms of mortality associated with VTE, major bleeding, and adverse events.
PMID: 34934566 | PMC: PMC8684043 | DOI: 10.7759 / cureus.19691