Home > Search Results


Venous thromboembolic (VTE) events are important causes of morbidity in elective total hip replacement (THR) and total knee replacement (TKR) procedures, which are being performed with increasing frequency in an aging population. Because of the substantial risk of VTE, current guidelines recommend thromboprophylaxis in patients undergoing THR or TKR.– Low molecular weight heparin (LMWH) and adjusted-dose warfarin are the most commonly used anticoagulants for thromboprophylaxis in the United States, but a number of pharmacological treatment options are available including unfractionated heparin, aspirin, and newer oral anticoagulants. These drug classes differ in practical applications such as a predictable dose-response and the need for laboratory monitoring, oral versus injection administration, dosing frequency, drug-drug interactions, and the availability of an appropriate reversal mechanism in case of over anticoagulation. In addition, mechanical thromboprophylaxis, most frequently used in combination with anticoagulants, is commonly used in the United States.


We identified six good-quality SRs that evaluated thromboprophylaxis using newer oral anticoagulants versus LMWH. One SR evaluated additional drug classes, including unfractionated heparin, aspirin, and vitamin K antagonists. Although we identified no direct comparisons of newer oral anticoagulants, two good-quality SRs indirectly compared one newer oral anticoagulant with another through common comparison to enoxaparin., Only one SR compared combined pharmacologic and mechanical thromboprophylaxis to either method alone. FXa inhibitors have been studied more extensively than DTIs. In the absence of head-to-head comparisons between newer oral anticoagulants, it is difficult to draw strong conclusions on inter- or intra-drug class differences. The main findings and strength of evidence from our literature synthesis are summarized by key question in the section that follows.


The flow of articles through the literature search and screening process is illustrated in Figure 2. Our search for systematic reviews (SRs) identified 162 unique citations from a combined search of MEDLINE via PubMed (n=117), Embase (n=42), and the Cochrane Database of Systematic Reviews (n=3). Manual searching of included study bibliographies and review articles added 20 more citations for a total of 182 unique citations. After applying inclusion and exclusion criteria at the title-and-abstract level, 47 full-text articles were retrieved and screened. Of these, 38 were excluded at the full-text screening stage, leaving 9 articles (representing 9 unique studies) for data abstraction. After further review, we excluded three systematic reviews– because they reviewed only one drug of interest and all of the primary studies included in these systematic reviews were already represented in another, more comprehensive included review. Thus, the final set of articles used in this evidence report comprises six systematic reviews.

Recent Activity

    Your browsing activity is empty.

    Activity recording is turned off.

    Turn recording back on

    See more...