 |
|
Reduction of Out-of-Hospital Symptomatic Venous Thromboembolism by Extended Thromboprophylaxis With Low-Molecular-Weight Heparin Following Elective Hip Arthroplasty
A Systematic Review
Martin O'Donnell, MB, MRCPI;
Lori-Ann Linkins, MD, FRCPC;
Clive Kearon, MB, MRCPI, FRCPC, PhD;
Jim Julian, MMath;
Jack Hirsh, MD, FRCPC, FRCPA
Arch Intern Med. 2003;163:1362-1366.
Background Numerous trials and meta-analyses have shown that extended out-of-hospital prophylaxis with low-molecular-weight heparin reduces asymptomatic and symptomatic venous thromboembolism after total hip arthroplasty. We hypothesized that knowledge of the results of screening tests may have resulted in overdiagnosis of symptomatic venous thromboembolism in many of these studies. The purpose of this analysis was to obtain an accurate estimate of the absolute risk reduction (ARR) of symptomatic venous thromboembolism after discharge from hospital in controlled studies that avoided this potential bias for overdiagnosis.
Methods Articles were identified using MEDLINE, EMBASE, and the Cochrane Library databases (January 1980–April 2002). Studies were eligible if the assessment of symptomatic venous thromboembolism was standardized and performed independently of mandatory objective testing.
Results Two studies (907 patients) were eligible for assessment of symptomatic venous thromboembolism, 5 studies (1917 patients) for symptomatic pulmonary embolism, and 7 studies (2425 patients) for fatal pulmonary embolism. In controls vs extended treatment groups, after hospital discharge, the frequency of symptomatic venous thromboembolism was 2.7% vs 1.1% (ARR, 1.56%; 95% confidence interval [CI], -0.21% to 3.3%; number needed to treat, 64); symptomatic pulmonary embolism was 0.36% vs 0% (ARR, 0.36%; 95% CI, -0.3% to 1.36%; number needed to treat, 278); and fatal pulmonary embolism was 0.09% vs 0% (ARR, 0.09%; 95% CI, -0.08% to 0.27%; number needed to treat, 1093).
Conclusions The absolute reduction in symptomatic venous thromboembolism attributed to extended prophylaxis in some studies and meta-analyses seems to have been overestimated.
From the Henderson Research Centre (Drs O'Donnell, Linkins, and Hirsh) and Thromboembolism Unit (Dr Kearon), Department of Medicine, and Department of Clinical Epidemiology and Biostatistics (Mr Julian), McMaster University, Hamilton, Ontario. The authors have no relevant financial interest in this article.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Rivaroxaban versus Enoxaparin for Thromboprophylaxis after Hip Arthroplasty
Eriksson et al.
NEJM 2008;358:2765-2775.
ABSTRACT
| FULL TEXT
Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Geerts et al.
Chest 2008;133:381S-453S.
ABSTRACT
| FULL TEXT
The Safety and Efficacy of Extended Thromboprophylaxis With Fondaparinux After Major Orthopedic Surgery of the Lower Limb With or Without a Neuraxial or Deep Peripheral Nerve Catheter: The EXPERT Study
Singelyn et al.
Anesth. Analg. 2007;105:1540-1547.
ABSTRACT
| FULL TEXT
Epidemiology of post-operative venous thromboembolism in Asian patients. Results of the SMART venography study
Leizorovicz and SMART Venography Study Steering Committee
haematol 2007;92:1194-1200.
ABSTRACT
| FULL TEXT
The Cost-Effectiveness of Extended-Duration Antithrombotic Prophylaxis After Total Hip Arthroplasty
Skedgel et al.
JBJS 2007;89:819-828.
ABSTRACT
| FULL TEXT
Methodological issues in trials assessing primary prophylaxis of venous thrombo-embolism
Thabut et al.
Eur Heart J 2006;27:227-236.
ABSTRACT
| FULL TEXT
Prevention of Venous Thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Geerts et al.
Chest 2004;126:338S-400S.
ABSTRACT
| FULL TEXT
|
