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Venous Thromboembolism Prophylaxis in Orthopedic Surgery

Slide: 12 of 30

Comparative Effectiveness of Pharmacological Prophylaxis Versus No Pharmacological Prophylaxis: Adverse Effects

There is a high level of evidence that pharmacological prophylaxis versus no prophylaxis significantly decreases the occurrence of proximal deep vein thrombosis (DVT) [RR 0.53 (0.39 to 0.74)] and distal DVT [RR 0.59 (0.42 to 0.82)] while significantly increasing minor bleeding [RR 1.67 (1.18 to 2.38)]. Pharmacological prophylaxis versus no prophylaxis did not significantly impact nonfatal pulmonary embolism, mortality, symptomatic DVT, or major bleeding in patients undergoing major orthopedic surgery. No clinical trials evaluated the impact of pharmacological prophylaxis versus no prophylaxis on reoperation and readmission. A single observational study evaluated the impact of pharmacological prophylaxis versus no prophylaxis on reoperation and readmission. Pharmacological prophylaxis increased reoperation but did not impact readmission. Pharmacological prophylaxis versus no prophylaxis did not significantly impact fatal pulmonary embolism, mortality due to bleeding, major bleeding leading to reoperation, and bleeding leading to transfusion in patients undergoing major orthopedic surgery; however, the impact is based on the results of a single trial for each end point because the rest of the trials evaluating these end points reported no events in the two comparative groups. No data are available to evaluate the comparative effect of pharmacological prophylaxis versus no prophylaxis on post-thrombotic syndrome, health-related quality of life, surgical site bleeding, bleeding leading to infection, heparin-induced thrombocytopenia, and discomfort in patients undergoing major orthopedic surgery.