Venous Thromboembolism Prophylaxis in Orthopedic Surgery
Comparative Effectiveness of Pharmacological and Mechanical Prophylaxis
Pharmacological Versus Mechanical Prophylaxis
Warfarin had significantly fewer proximal DVT events versus mechanical prophylaxis [RR 0.34 (95% CI 0.16 to 0.73); NNT 11 to 31]. The strength of evidence for this finding was moderate.
- Warfarin had significantly fewer proximal DVT events versus mechanical prophylaxis in total hip replacement surgery.
Aspirin had significantly more DVT events versus mechanical prophylaxis [RR 1.63 (95% CI 1.11 to 2.39)]. The strength of evidence for this finding was moderate.
- Aspirin had significantly more DVT events versus mechanical prophylaxis in total knee replacement surgery.
Pharmacological Plus Mechanical Prophylaxis Versus Pharmacological Prophylaxis
Pharmacological plus mechanical prophylaxis versus pharmacological prophylaxis alone decreased the risk for DVT events [RR 0.48 (95% CI 0.32 to 0.72); NNT 3 to 67]. The strength of evidence for this finding was moderate.
Pharmacological plus mechanical versus pharmacological prophylaxis alone had similar results for pulmonary embolism, nonfatal pulmonary embolism, and proximal DVT. The strength of evidence for this finding was low.
Abbreviations: 95% CI = 95-percent confidence interval; DVT = deep vein thrombosis; NNT = number needed to treat (the calculated range); RR = relative risk
Keywords: bleeding | deep vein thrombosis | desirudin | low-molecular-weight heparin | magnitude of effect | pharmacological prophylaxis | pulmonary embolism | strength of evidence | total hip replacement | total knee replacement | unfractionated heparin | venous thromboembolism | warfarin | orthopedic surgery
- Sobieraj DM, Coleman CI, Tongbram V, et al. Venous Thromboembolism in Orthopedic Surgery. Comparative Effectiveness Review No. 49 (Prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center under Contract No. 290-2007-10067-I). Rockville, MD: Agency for Healthcare Research and Quality; March 2012. AHRQ Publication No. 12-EHC020-EF. Available at www.effectivehealthcare.ahrq.gov/thrombo.cfm.
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