Mechanical Prophylaxis Compared with Low-molecular-weight Heparins for Preventing Venous Thrombosis after Orthopedic Surgery: A Systematic and Meta-analysis
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Background : Mechanical prophylaxis (MP) and low-molecular-weight heparins (LMWHs) have been widely used after patient undergoing orthopedic surgery. However, their efficacy in preventing venous thrombus remains unclear. Methods : PubMed, Embase and Cochrane library databases were systematically searched for studies that investigated the effectiveness between MP and LMWHs. Predefined outcomes were incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), proximal DVT and major bleeding using random-effects models. Results : A total of 8 randomized controlled trials (RCTs) on 2899 patients were eligible for inclusion. No significant difference was observed between MP and LMWHs for the prevention of DVT (RR 1.37; 95% CI: 0.83-2.26), PE (RR 1.35; 95% CI: 0.41-4.41), or proximal DVT (RR 1.30; 95% CI: 0.55- 3.02). However, there was a significant reduction of major bleeding (RR 0.21; 95% CI: 0.05-0.82). Predefined subgroup analysis suggested that MP might enhance the occurrence of DVT in comparison with fixed-dose LMWHs (RR 1.61; 95% CI: 1.09-2.37), but not in the subgroup with adjusted-weight LMWHs (RR 0.38; 95% CI, 0.11-1.30). Without combining graduated compression stockings (GCS) in both groups, the incidence of DVT was significantly associated with MP (RR 1.88; 95% CI: 1.01-3.21). Conclusions : Results of this meta-analysis suggested, compared to LMWHs, MP might have no significance in the prevention of DVT, although it was associated with lower incidence of major bleeding after patients underwent orthopedic surgery. However, subgroup analyses suggested that fixed-based LMWHs or application one of mechanical types without GCS might have differential effects. Therefore, large-scaled and well-designed RCTs are needed in the future.
Abstract
Background : Mechanical prophylaxis (MP) and low-molecular-weight heparins (LMWHs) have been widely used after patient undergoing orthopedic surgery. However, their efficacy in preventing venous thrombus remains unclear. Methods : PubMed, Embase and Cochrane library databases were systematically searched for studies that investigated the effectiveness between MP and LMWHs. Predefined outcomes were incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), proximal DVT and major bleeding using random-effects models. Results : A total of 8 randomized controlled trials (RCTs) on 2899 patients were eligible for inclusion. No significant difference was observed between MP and LMWHs for the prevention of DVT (RR 1.37; 95% CI: 0.83-2.26), PE (RR 1.35; 95% CI: 0.41-4.41), or proximal DVT (RR 1.30; 95% CI: 0.55- 3.02). However, there was a significant reduction of major bleeding (RR 0.21; 95% CI: 0.05-0.82). Predefined subgroup analysis suggested that MP might enhance the occurrence of DVT in comparison with fixed-dose LMWHs (RR 1.61; 95% CI: 1.09-2.37), but not in the subgroup with adjusted-weight LMWHs (RR 0.38; 95% CI, 0.11-1.30). Without combining graduated compression stockings (GCS) in both groups, the incidence of DVT was significantly associated with MP (RR 1.88; 95% CI: 1.01-3.21). Conclusions : Results of this meta-analysis suggested, compared to LMWHs, MP might have no significance in the prevention of DVT, although it was associated with lower incidence of major bleeding after patients underwent orthopedic surgery. However, subgroup analyses suggested that fixed-based LMWHs or application one of mechanical types without GCS might have differential effects. Therefore, large-scaled and well-designed RCTs are needed in the future.
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