Prolonged Versus Standard-Duration Venous Thromboprophylaxis in Major Orthopedic Surgery

Abstract

Prolonged prophylaxis decreases the risk for venous thromboembolism, PE, and DVT while increasing the risk for minor bleeding in patients undergoing total hip replacement.

Effectiveness and safety of different duration of thromboprophylaxis in 16,865 hip replacement patients - A real-word, prospective observational study

“…Two systematic reviews based on older clinical trials [32,33] concluded that extended thromboprophylaxis is more efficacious than a shorter course of treatment for preventing VTE or VTE-related deaths while increasing the risk of minor bleeding, a finding that does not agree with our study. However, in a systemic review, O'Donnell M et al [34] reported statistically non-significant absolute risk reduction of symptomatic VTE in patients treated with extended prophylaxis compared with those treated with standard duration.…”

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

“…Fondaparinux or low-molecular weight heparin for 28 to 35 days after surgery seems to be the best evidence-based recommendation at this time. 43,186,187 Warfarin is an alternative reasonable choice for therapy and is often used in patients who were taking warfarin prior to fracture.…”

Risk of major bleeding in different indications for new oral anticoagulants: Insights from a meta-analysis of approved dosages from 50 randomized trials

“…Higher rate of major bleeding in hip surgery but not in knee surgery may be related to the longer duration of NOAC therapy and higher baseline risk in subjects undergoing hip surgery [21,22]. Another point to consider is that comparator groups in most of the trials of hip surgery received 40 mg daily LMWH (approved dose in Europe), while the majority of the comparator groups in knee surgery received 30 mg twice daily (i.e.…”