Pharmacotherapy for Venous Thromboprophylaxis following Total Hip or Knee Arthroplasty: A Systematic Review and Network Meta-analysis.

Autor:	Yong BSJ; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore., Ling RR; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore., Li R; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore., Poh JW; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore., Tan CS; Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore., Ho SWL; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.; Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore., Rochwerg B; Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada., Arya R; Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital Foundation NHS Trust, London, United Kingdom., Ramanathan K; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore., Fan BE; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.; Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore.
Jazyk:	angličtina
Zdroj:	Seminars in thrombosis and hemostasis [Semin Thromb Hemost] 2024 Jul 01. Date of Electronic Publication: 2024 Jul 01.
DOI:	10.1055/s-0044-1787996
Abstrakt:	The optimal pharmacological prophylaxis for venous thromboembolism (VTE) after hip or knee arthroplasty is uncertain. We conducted a systematic review and network meta-analysis to compare the efficacy and safety of various medications. We searched multiple databases for randomized clinical trials (RCTs) comparing medications (including factor Xa inhibitors, factor IIa inhibitor, warfarin, unfractionated heparin [UFH], low-molecular-weight heparin [LMWH], aspirin, pentasaccharide) for VTE prophylaxis post-arthroplasty. Outcomes included any postoperative VTE identified with screening, major bleeding, and death. We used LMWH as the main comparator for analysis and performed trial sequential analysis (TSA) for each pairwise comparison. Certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessments, Developments and Evaluations). We analyzed 70 RCTs (55,841 participants). Factor Xa inhibitors decreased postoperative VTE significantly compared with LMWH (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.44-0.68, high certainty). Pentasaccharides probably reduce VTE (OR: 0.61, 95% CI: 0.36-1.02, moderate certainty), while the factor IIa inhibitor dabigatran may reduce VTE (OR: 0.75, 95% CI: 0.40-1.42, low certainty). UFH probably increases VTE compared with LMWH (OR: 1.31, 95% CI: 0.91-1.89, moderate certainty), and other agents like warfarin, aspirin, placebo, and usual care without thromboprophylaxis increase VTE (high certainty). Factor Xa inhibitors may not significantly affect major bleeding compared with LMWH (OR: 1.06, 95% CI: 0.81-1.39, low certainty). No medications had a notable effect on mortality compared with LMWH (very low certainty). TSA suggests sufficient evidence for the benefit of factor Xa inhibitors over LMWH for VTE prevention. Compared with LMWH and aspirin, factor Xa inhibitors are associated with reduced VTE after hip or knee arthroplasty, without an increase in bleeding and likely no impact on mortality. Competing Interests: R.R.L. receives research support from the Clinician Scientist Development Unit, Yong Loo Lin School of Medicine, Singapore. All other authors declare no competing interests. (Thieme. All rights reserved.)
Databáze:	MEDLINE
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