Efficacy and safety of commonly used thromboprophylaxis agents following hip and knee arthroplasty.

Autor:	Cheok T; Department of Orthopaedic Surgery, Lyell McEwin Hospital, Adelaide, Australia.; Department of Orthopaedic Surgery, Palmerston North Hospital, Palmerston North, New Zealand.; College of Medicine and Public Health, Flinders University, Adelaide, Australia., Beveridge A; Department of Orthopaedic Surgery, Palmerston North Hospital, Palmerston North, New Zealand.; School of Medicine, Cardiff University, Neuadd Meirionnydd, Cardiff, UK., Berman M; Department of Orthopaedic Surgery, Monash Medical Centre, Melbourne, Australia., Coia M; Department of Orthopaedic Surgery, Palmerston North Hospital, Palmerston North, New Zealand., Campbell A; Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand., Tse TTS; Department of Orthopaedic Surgery, Palmerston North Hospital, Palmerston North, New Zealand., Doornberg JN; College of Medicine and Public Health, Flinders University, Adelaide, Australia.; Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia.; Department of Orthopaedic Surgery, University Medical Centre Groningen, Groningen, Netherlands., Jaarsma RL; College of Medicine and Public Health, Flinders University, Adelaide, Australia.; Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia.
Jazyk:	angličtina
Zdroj:	The bone & joint journal [Bone Joint J] 2024 Sep 01; Vol. 106-B (9), pp. 924-934. Date of Electronic Publication: 2024 Sep 01.
DOI:	10.1302/0301-620X.106B9.BJJ-2023-1252.R2
Abstrakt:	Aims: We investigated the efficacy and safety profile of commonly used venous thromboembolism (VTE) prophylaxis agents following hip and knee arthroplasty. Methods: A systematic search of PubMed, Embase, Cochrane Library, Web of Science, and OrthoSearch was performed. Prophylaxis agents investigated were aspirin (< 325 mg and ≥ 325 mg daily), enoxaparin, dalteparin, fondaparinux, unfractionated heparin, warfarin, rivaroxaban, apixaban, and dabigatran. The primary efficacy outcome of interest was the risk of VTE, whereas the primary safety outcomes of interest were the risk of major bleeding events (MBE) and wound complications (WC). VTE was defined as the confirmed diagnosis of any deep vein thrombosis and/or pulmonary embolism. Network meta-analysis combining direct and indirect evidence was performed. Cluster rank analysis using the surface under cumulative ranking (SUCRA) was applied to compare each intervention group, weighing safety and efficacy outcomes. Results: Of 86 studies eligible studies, cluster rank analysis showed that aspirin < 325 mg daily (SUCRA-VTE 89.3%; SUCRA-MBE 75.3%; SUCRA-WC 71.1%), enoxaparin (SUCRA-VTE 55.7%; SUCRA-MBE 49.8%; SUCRA-WC 45.2%), and dabigatran (SUCRA-VTE 44.9%; SUCRA-MBE 52.0%; SUCRA-WC 41.9%) have an overall satisfactory efficacy and safety profile. Conclusion: We recommend the use of either aspirin < 325 mg daily, enoxaparin, or dabigatran for VTE prophylaxis following hip and knee arthroplasty. Competing Interests: None declared. (© 2024 The British Editorial Society of Bone & Joint Surgery.)
Databáze:	MEDLINE
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