Table 9-44Summary of evidence from network meta-analysis results for DVT, symptomatic pulmonary embolism and major bleeding outcomes

Intervention(s)Comparison(s)Intervention favoured
DVTPEMB
Prophylaxis vs no prophylaxis
GCSno prophylaxisGCSNot sig-
IPCD/FIDno prophylaxisIPCD/FIDNot sig-
Fondaparinuxno prophylaxisFondaparinuxNot sigNo prophylaxis
LMWHno prophylaxisLMWHLMWHNo prophylaxis
UFHno prophylaxisUFHNot sigNo prophylaxis
VKA (adjusted dose)no prophylaxisVKANot sigNo prophylaxis
Aspirin (high-dose)no prophylaxisAspirinAspirinNot Sig
Fondaparinux + IPCD/FIDno prophylaxisFondaparinux + IPCD/FIDNot sigNo prophylaxis
LMWH + GCSno prophylaxisLMWH + GCS-No prophylaxis
UFH + GCSno prophylaxisUFH + GCSNot sigNo prophylaxis
UFH + aspirin (high-dose)no prophylaxisUFH + aspirinUFH + aspirinNo prophylaxis
Cost-effectiveness results
GCS was the most clinically effective and cost effective strategy. At lower levels of bleeding risk, combination prophylaxis (e.g. UFH+GCS) was most cost-effective.
The re was one situation in the deterministic sensitivity analysis in which the most cost effective strategy changed was that high dose aspirin alone was the most cost effective strategy when the population specific pulmonary embolism relative risks were used.
Post discharge LMWH was cost effective in cancer surgery patients

The VTE prophylaxis strategy which is significantly more effective in reducing DVT or PE, or resulting in significantly less major bleeding is stated in bold. Not sig = not statistically significant difference. No event= outcomes reported in study(ies) but no events were reported. ‘-’ = not reported. MB = Major bleeding

From: 9, Gastrointestinal, gynaecological, laparoscopic, thoracic and urological surgery

Cover of Venous Thromboembolism
Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital.
NICE Clinical Guidelines, No. 92.
National Clinical Guideline Centre – Acute and Chronic Conditions (UK).
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