Comparison of Surgical Site Infection Risk between Warfarin, Low Molecular Weight Heparin and Aspirin When Used for Venous Thromboprophylaxis Following Knee or Hip Arthroplasty- A Systematic Review and Meta-Analysis of 9 Studies Including 184,105 Cases

2019 ◽  
Author(s):  
Luke Hughes ◽  
Joann Lum ◽  
Ziyad Mahfoud ◽  
Rayaz Malik ◽  
Anoop Anand ◽  
...  
Keyword(s):  
Systematic Review ◽  
Molecular Weight ◽  
Surgical Site Infection ◽  
Hip Arthroplasty ◽  
Low Molecular Weight Heparin ◽  
Meta Analysis ◽  
Infection Risk ◽  
Low Molecular Weight ◽  
Site Infection

scholarly journals Low Dose Low-Molecular-Weight Heparin for Thrombosis Prophylaxis: Systematic Review with Meta-Analysis and Trial Sequential Analysis

2019 ◽  
Vol 8 (12) ◽  
pp. 2039 ◽  
Author(s):  
Ruben J. Eck ◽  
Wouter Bult ◽  
Jørn Wetterslev ◽  
Reinold O. B. Gans ◽  
Karina Meijer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Sequential Analysis ◽  
Low Dose ◽  
Meta Analysis ◽  
Trial Sequential Analysis ◽  
Thrombosis Prophylaxis ◽  
Low Molecular Weight ◽  
All Cause Mortality

International guidelines recommend low-molecular-weight heparin (LMWH) as first-line pharmacological option for the prevention of venous thromboembolism (VTE) in many patient categories. Guidance on the optimal prophylactic dose is lacking. We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized controlled trials to assess benefits and harms of low-dose LMWH versus placebo or no treatment for thrombosis prophylaxis in patients at risk of VTE. PubMed, Cochrane Library, Web of Science, and Embase were searched up to June 2019. Results were presented as relative risk (RR) with conventional and TSA-adjusted confidence intervals (CI). Forty-four trials with a total of 22,579 participants were included. Six (14%) had overall low risk of bias. Low-dose LMWH was not statistically significantly associated with all-cause mortality (RR 0.99; 95%CI 0.85–1.14; TSA-adjusted CI 0.89–1.16) but did reduce symptomatic VTE (RR 0.62; 95%CI 0.48–0.81; TSA-adjusted CI 0.44–0.89) and any VTE (RR 0.61; 95%CI 0.50–0.75; TSA-adjusted CI 0.49–0.82). Analyses on major bleeding (RR 1.07; 95%CI 0.72–1.59), as well as serious adverse events (SAE) and clinically relevant non-major bleeding were inconclusive. There was very low to moderate-quality evidence that low-dose LMWH for thrombosis prophylaxis did not decrease all-cause mortality but reduced the incidence of symptomatic and asymptomatic VTE, while the analysis of the effects on bleeding and adverse events remained inconclusive.

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