Prophylaxis against venous thromboembolism in orthopedic surgery.

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Abstract

[Indexed for MEDLINE] 17. Injury. 2022 Apr;53(4):1449-1454. doi: 10.1016/j.injury.2022.01.045. Epub 2022 Feb 5. Chemoprophylaxis for venous thromboembolism in pelvic and/or acetabular fractures: A systematic review. Shu HT(1), Yu AT(2), Lim PK(3), Scolaro JA(3), Shafiq B(4). Author information: (1)Department of Orthopaedic Surgery, The Johns Hopkins University, 601N Caroline St 5th floor, Baltimore, MD 21205, United States. (2)Department of Neurology, The Johns Hopkins University, Baltimore, MD, United States. (3)Department of Orthopaedic Surgery, University of California, Irvine, Irvine, CA, United States. (4)Department of Orthopaedic Surgery, The Johns Hopkins University, 601N Caroline St 5th floor, Baltimore, MD 21205, United States. Electronic address: bshafiq2@jhmi.edu. BACKGROUND: It is unclear which pharmacological agents, and at what dosage and timing, are most effective for venous thromboembolism (VTE) prophylaxis in patients with pelvic/acetabular fractures. METHODS: We searched the Cochrane Database of Systematic Reviews, Embase, Web of Science, EBSCO, and PubMed on October 3, 2020, for English-language studies of VTE prophylaxis in patients with pelvic/acetabular fractures. We applied no date limits. We included studies that compared efficacy of pharmacological agents for VTE prophylaxis, timing of administration of such agents, and/or dosage of such agents. We recorded interventions, sample sizes, and VTE incidence, including deep vein thrombosis (DVT) and pulmonary embolism. RESULTS: Two studies (3604 patients) compared pharmacological agents, reporting that patients who received direct oral anticoagulants (DOACs) were less likely to develop DVT than those who received low molecular weight heparin (LMWH) (p < 0.01). Compared with unfractionated heparin (UH), LMWH was associated with lower odds of VTE (odds ratio [OR] = 0.37, 95% confidence interval [CI]: 0.22-0.63) and death (OR = 0.27, 95% CI: 0.10-0.72). Three studies (3107 patients) compared timing of VTE prophylaxis, reporting that late prophylaxis was associated with higher odds of VTE (OR = 1.9, 95% CI: 1.2-3.2) and death (OR = 4.0, 95% CI: 1.5-11) and higher rates of symptomatic DVT (9.2% vs. 2.5%, p = 0.03; and 22% vs. 3.1%, p = 0.01). One study (31 patients) investigated dosage of VTE prophylaxis, reporting that a higher proportion of patients with acetabular fractures were underdosed (23% of patients below range of anti-Factor Xa [aFXa] had acetabular fractures vs. 4.8% of patients within adequate range of aFXa, p