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Venous Thromboembolism Prophylaxis in Orthopedic Surgery

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Comparative Effectiveness of Pharmacological or Mechanical Thromboprophylaxis Versus No Thromboprophylaxis

Twenty randomized controlled trials (RCTs; N = 2,868) and three controlled observational studies (N = 12,866) evaluated the impact of combined pharmacological and mechanical modalities versus no thromboprophylaxis on final health, intermediate, and adverse outcomes. Eighteen RCTs compared pharmacological prophylaxis to no prophylaxis; of these, 11 compared pharmacological prophylaxis with truly no prophylaxis. Two RCTs compared mechanical prophylaxis with no prophylaxis; of these, one compared mechanical prophylaxis with truly no prophylaxis. To qualify as being “truly no prophylaxis,” the trials had to compare pharmacological or mechanical prophylaxis with placebo or no prophylaxis without the use of any concurrent prophylaxis in the groups compared; whereas, in the broader category of studies comparing pharmacological or mechanical prophylaxis versus placebo or no prophylaxis with concurrent use of graduated compression stockings in the groups compared were also included. Fourteen trials exclusively enrolled patients who had total hip replacement surgery (N = 2,069), four trials enrolled patients who had total knee replacement surgery (N = 537), and two trials enrolled patients who had hip fracture surgery (N = 262). The earliest trial was published in 1980, while the most recent was published in 2011. The duration of followup ranged from the postoperative period to 90 days. The mean age of enrolled patients ranged from 60.6 years to 79 years. Females represented between 18.0 and 91.82 percent of the enrolled populations. The mean weight ranged from 54.2 to 74.0 kilograms, with only one trial reporting obesity, which ranged from 21.43 to 59.4 percent. Few patients enrolled had a history of venous thromboembolism, with the majority of trials reporting 0 to 10.0 percent. Presence of varicosity ranged from no varicosity to 55.0 percent. The percentage of patients with a history of malignancy ranged from 0.0 to 7.1. None of the trials reported the percentage of patients who had previously undergone orthopedic surgery.