The Resource Venous thromboembolism prophylaxis in major orthopedic surgery : systematic review update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Brown Evidence-based Practice Center ; investigators, Ethan M. Balk, Alexandra G. Ellis, Mengyang Di, Gaelen P. Adam, Thomas A. Trikalinos

Venous thromboembolism prophylaxis in major orthopedic surgery : systematic review update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Brown Evidence-based Practice Center ; investigators, Ethan M. Balk, Alexandra G. Ellis, Mengyang Di, Gaelen P. Adam, Thomas A. Trikalinos

Label
Venous thromboembolism prophylaxis in major orthopedic surgery : systematic review update
Title
Venous thromboembolism prophylaxis in major orthopedic surgery
Title remainder
systematic review update
Statement of responsibility
prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Brown Evidence-based Practice Center ; investigators, Ethan M. Balk, Alexandra G. Ellis, Mengyang Di, Gaelen P. Adam, Thomas A. Trikalinos
Creator
Contributor
Author
Issuing body
Publisher
Sponsoring body
Subject
Genre
Language
eng
Summary
BACKGROUND: Major orthopedic surgeries, such as total knee replacement (TKR), total hip replacement (THR), and hip fracture (HFx) surgery, carry a high risk for venous thromboembolism (VTE)--deep vein thrombosis (DVT) and pulmonary embolism (PE). METHODS: Updating a 2012 review, we compare interventions to prevent VTE after TKR, THR, and HFx surgery. We searched four databases and other sources through June 3, 2016, for randomized controlled trials (RCTs) and large nonrandomized comparative studies (NRCSs) reporting postoperative VTE, major bleeding, and other adverse events. We conducted pairwise meta-analyses, Bayesian network meta-analyses, and strength of evidence (SoE) synthesis. RESULTS: Overall, 127 RCTs and 15 NRCSs met criteria. For THR: low molecular weight heparin (LMWH) has lower risk than unfractionated heparin (UFH) of various VTE outcomes (moderate to high SoE) and major bleeding (moderate SoE). LMWH and aspirin have similar risks of total PE, symptomatic DVT, and major bleeding (low SoE). LMWH has less major bleeding (low SoE) than direct thrombin inhibitors (DTI), but DTI has lower DVT risks (moderate SoE). LMWH has less major bleeding than vitamin K antagonists (VKA) (high SoE). LMWH and factor Xa inhibitor (FXaI) comparisons are inconsistent across VTE outcomes, but LMWH has less major bleeding (high SoE). VKA has lower proximal DVT risk than mechanical devices (high SoE). Longer duration LMWH has lower risk of various VTE outcome risks (low to high SoE). Higher dose LMWH has lower total DVT risk (low SoE) but more major bleeding (moderate SoE). Higher dose FXaI has lower total VTE risk (low SoE). For TKR: LMWH has lower DVT risks than VKA (low to high SoE), but VKA has less major bleeding (low SoE). FXaI has lower risk than LMWH of various VTE outcomes (low to moderate SoE), but LMWH has less major bleeding (low SoE) and more study-defined serious adverse events (low SoE). Higher dose DTI has lower DVT risk (moderate to high SoE) but more major bleeding (low SoE). Higher dose FXaI has lower risk of various VTE outcomes (low to moderate SoE). For HFx surgery: LMWH has lower total DVT risk than FXaI (moderate SoE). CONCLUSIONS: VTE prophylaxis after major orthopedic surgery trades off lowered VTE risk with possible adverse events--in particular, for most interventions, major bleeding. In THR, LMWH has lower VTE and adverse event risks than UFH, LMWH and aspirin have similar risks of VTE and major bleeding, DTI has lower DVT risk than LMWH but higher major bleeding risk, and higher dose LMWH has lower DVT risk but higher major bleeding risk than lower dose. In TKR, VKA has higher DVT risk than LMWH but lower major bleeding risk, and higher dose DTI has lower DVT risk but higher major bleeding risk than lower dose. In HFx surgery and for other intervention comparisons, there is insufficient evidence to assess both benefits and harms, or findings are inconsistent. Importantly, though, most studies evaluate "total DVT" (an outcome of unclear clinical significance since it includes asymptomatic and other low-risk DVTs), but relatively few studies evaluate PE and other clinically important outcomes. This limitation yields a high likelihood of selective outcome reporting bias. There is also relatively sparse evidence on interventions other than LMWH
Member of
Cataloging source
NLM
http://library.link/vocab/creatorName
Balk, Ethan
Funding information
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; prepared by: Brown Evidence-based Practice Center
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • surveys of literature
NLM call number
WG 610
http://library.link/vocab/relatedWorkOrContributorName
  • Ellis, Alexandra G.
  • Di, Mengyang
  • Adam, Gaelen Phyfe
  • Trikalinos, Thomas A.
  • United States
  • Brown University Center for Evidence-Based Medicine
  • Effective Health Care Program (U.S.)
Series statement
  • Comparative effectiveness review
  • AHRQ publication
Series volume
  • number 191
  • no. 17-EHC021-EF
http://library.link/vocab/subjectName
  • Venous Thromboembolism
  • Venous Thromboembolism
  • Orthopedic Procedures
  • Intraoperative Complications
  • Treatment Outcome
  • Primary Prevention
Label
Venous thromboembolism prophylaxis in major orthopedic surgery : systematic review update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Brown Evidence-based Practice Center ; investigators, Ethan M. Balk, Alexandra G. Ellis, Mengyang Di, Gaelen P. Adam, Thomas A. Trikalinos
Instantiates
Publication
Note
"June 2018."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Color
multicolored
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
1030588123
Dimensions
unknown
Extent
1 online resource (various pagings)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)1030588123
Label
Venous thromboembolism prophylaxis in major orthopedic surgery : systematic review update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Brown Evidence-based Practice Center ; investigators, Ethan M. Balk, Alexandra G. Ellis, Mengyang Di, Gaelen P. Adam, Thomas A. Trikalinos
Publication
Note
"June 2018."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Color
multicolored
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
1030588123
Dimensions
unknown
Extent
1 online resource (various pagings)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)1030588123

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