Premium
Prevention of venous thromboembolism in orthopedic surgery with vitamin K antagonists: a meta‐analysis
Author(s) -
Mismetti P.,
Laporte S.,
Zufferey P.,
Epinat M.,
Decousus H.,
Cucherat M.
Publication year - 2004
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2004.00757.x
Subject(s) - medicine , relative risk , orthopedic surgery , confidence interval , surgery , pulmonary embolism , deep vein , randomized controlled trial , placebo , number needed to treat , hematoma , venous thrombosis , thrombosis , vitamin k antagonist , warfarin , atrial fibrillation , alternative medicine , pathology
Summary. Background : The benefit‐to‐risk ratio of vitamin K antagonists (VKA), relative to active comparators, especially low‐molecular‐weight heparins (LMWH), for preventing venous thromboembolism in patients undergoing major orthopedic surgery is debated. Objectives : We performed a meta‐analysis of all randomized trials in orthopedic surgery comparing adjusted doses of VKA to control treatments. Patients and methods : An exhaustive literature search, both manual and computer‐assisted, was performed. Studies were selected on the basis of randomization procedure (VKA vs. a control group). At least one of the following outcome measures was to be evaluated: deep vein thrombosis (DVT), pulmonary embolism (PE), death, major hemorrhage or wound hematoma. Four reviewers assessed each article to determine eligibility for inclusion and outcome measures. Results: VKAs were more effective than placebo or no treatment in reducing DVT [567 patients, relative risk (RR) = 0.56, 95% confidence interval (CI) 0.37, 0.84, P < 0.01] and clinical PE (651 patients, RR = 0.23, 95% CI 0.09, 0.59, P < 0.01). These results were obtained at the cost of a higher rate of wound hematoma (162 patients, RR = 2.91, 95% CI 1.09, 7.75, P = 0.03). VKAs were also more effective than intermittent pneumatic compression (534 patients, RR = 0.46, 95% CI 0.25, 0.82, P = 0.009) in preventing proximal DVT. In contrast, VKAs were less effective than LMWH in preventing total DVT and proximal DVT (9822 patients, RR = 1.51, 95% CI 1.27, 1.79, P < 0.001; and 6131 patients, RR = 1.51, 95% CI 1.04, 2.17, P = 0.028, respectively). The differences between VKA and LMWH in major hemorrhage and wound hematoma were not significant. Conclusions : In patients undergoing major orthopedic surgery, VKAs are less effective than LMWH, without any significant difference in the bleeding risk.