Table 77Strength of evidence for final, intermediate and adverse outcomes comparing injectable low molecular weight heparin prophylaxis to injectable or oral direct thrombin inhibitors prophylaxis in patients who had major orthopedic surgery

Quality AssessmentSummary of Findings
OutcomeNumber of studiesDesignRisk of BiasConsistencyDirectnessPrecisionQuality
Symptomatic objectively confirmed VTE0---------------Insufficient
Major VTE3RCTNo limitationsNo inconsistencyNo indirectnessSerious imprecisionModerate
Pulmonary Embolism3RCTNo limitationsNo inconsistencyNo indirectnessSerious imprecisionModerate
Fatal pulmonary embolism3RCTNo limitationsNo inconsistencyNo indirectnessVery serious imprecisionLow
Nonfatal pulmonary embolism2RCTNo limitationsSerious inconsistencyNo indirectnessSerious imprecisionLow
Post thrombotic syndrome0---------------Insufficient
Mortality5RCTNo limitationNo inconsistencyNo indirectnessSerious imprecisionModerate
Mortality due to bleeding3RCTNo limitationsNANo indirectnessVery serious imprecisionInsufficient
Health related quality of life0---------------Insufficient
Deep vein thrombosis1RCTNo limitationsNANo indirectnessNo imprecisionInsufficient
Asymptomatic deep vein thrombosis2RCTNo limitationsNo inconsistencyNo indirectnessSerious imprecisionModerate
Symptomatic deep vein thrombosis4RCTNo limitationsNo inconsistencyNo indirectnessSerious imprecisionModerate
Proximal deep vein thrombosis3RCTNo limitationsSerious inconsistencyNo indirectnessSerious imprecisionLow
Distal deep vein thrombosis1RCTNo limitationsNo inconsistencyNo indirectnessNo imprecisionInsufficient
Major bleeding4RCTNo limitationsNo inconsistencyNo indirectnessSerious imprecisionModerate
Major bleeding leading to reoperation3RCTNo limitationsNo inconsistencyNo indirectnessSerious imprecisionModerate
Minor bleeding3RCTNo limitationsNo inconsistencyNo indirectnessSerious imprecisionModerate
Surgical site bleeding1RCTNo limitationsNo inconsistencyNo indirectnessVery serious imprecisionInsufficient
Bleeding leading to infection0---------------Insufficient
Bleeding leading to transfusion2RCTNo limitationsNo inconsistencyNo indirectnessNo imprecisionHigh
Heparin-induced thrombocytopenia0---------------Insufficient
Discomfort0---------------Insufficient
Readmission0---------------Insufficient
Reoperation0---------------Insufficient

Abbreviations: NA=not applicable; RCT: randomized controlled trial; VTE=venous thromboembolism

From: Appendix H, Strength of Evidence Rating

Cover of Venous Thromboembolism Prophylaxis in Orthopedic Surgery
Venous Thromboembolism Prophylaxis in Orthopedic Surgery [Internet].
Comparative Effectiveness Reviews, No. 49.
Sobieraj DM, Coleman CI, Tongbram V, et al.

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