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Low molecular weight heparin for the prevention of deep venous thrombosis after total knee arthroplasty: A systematic review and meta-analysis.
Int J Surg 2018; 54(Pt A):265-275IJ

Abstract

BACKGROUND

To systematically evaluate the prophylaxis efficacy of low-molecular-weight heparin (LMWH) in the prevention of deep venous thrombosis (DVT) after total knee arthroplasty (TKA).

METHOD

PubMed, Cochrane, Embase, Wanfang, CNKI, and VIP databases were searched by index words to identify the eligible RCTs; relevant literature sources were also searched. The latest research was conducted in March 2017. Relative risks (RR), mean difference (MD), and their corresponding 95% confidence intervals (95% CIs) were used to analyze the main outcomes.

RESULT

A total of 22 articles were included in the meta-analysis with a total number of 11,320 patients (5543 in the LMWH group and 5777 in the control group). The results indicated that in the LMWH group, the incidence of DVT (OR: 0.57, 95% CI: 0.41-0.77) and wound complications (SMD: 0.96, 95% CI: 0.75-1.22) was significantly lower than that in the control group. Furthermore, LMWH also increased the occurrence of bleeding event (OR: 1.57, 95% CI: 1.31-1.88) and the total blood transfused (SMD: 0.12, 95% CI: 0.04-0.19). However, no statistical difference was found in blood loss (SMD: -0.26, 95% CI: -0.65-0.14) between the two group. In the subgroup analysis, the incidence of DVT was significantly decreased in the ardeparin sodium group (OR: 0.70, 95%CI: 0.53-0.94) and the dalteparin group (OR:0.40, 95%CI:0.32-0.50).

CONCLUSION

Our meta-analysis demonstrated that LMWH is obviously efficacious in the prophylaxis of DVT after TKA. However, it has some negative effects, such as the increase in the number of bleeding events and the total blood transfused.

Authors+Show Affiliations

Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. Electronic address: xshweng@medmail.com.cn.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

29733996

Citation

Xia, Ze-Nan, et al. "Low Molecular Weight Heparin for the Prevention of Deep Venous Thrombosis After Total Knee Arthroplasty: a Systematic Review and Meta-analysis." International Journal of Surgery (London, England), vol. 54, no. Pt A, 2018, pp. 265-275.
Xia ZN, Zhou Q, Zhu W, et al. Low molecular weight heparin for the prevention of deep venous thrombosis after total knee arthroplasty: A systematic review and meta-analysis. Int J Surg. 2018;54(Pt A):265-275.
Xia, Z. N., Zhou, Q., Zhu, W., & Weng, X. S. (2018). Low molecular weight heparin for the prevention of deep venous thrombosis after total knee arthroplasty: A systematic review and meta-analysis. International Journal of Surgery (London, England), 54(Pt A), pp. 265-275. doi:10.1016/j.ijsu.2018.04.059.
Xia ZN, et al. Low Molecular Weight Heparin for the Prevention of Deep Venous Thrombosis After Total Knee Arthroplasty: a Systematic Review and Meta-analysis. Int J Surg. 2018;54(Pt A):265-275. PubMed PMID: 29733996.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low molecular weight heparin for the prevention of deep venous thrombosis after total knee arthroplasty: A systematic review and meta-analysis. AU - Xia,Ze-Nan, AU - Zhou,Qing, AU - Zhu,Wei, AU - Weng,Xi-Sheng, Y1 - 2018/05/04/ PY - 2017/06/19/received PY - 2018/03/23/revised PY - 2018/04/28/accepted PY - 2018/5/8/pubmed PY - 2018/10/10/medline PY - 2018/5/8/entrez KW - Deep venous thrombosis KW - Low-molecular-weight heparin KW - Meta-analysis KW - Total knee arthroplasty SP - 265 EP - 275 JF - International journal of surgery (London, England) JO - Int J Surg VL - 54 IS - Pt A N2 - BACKGROUND: To systematically evaluate the prophylaxis efficacy of low-molecular-weight heparin (LMWH) in the prevention of deep venous thrombosis (DVT) after total knee arthroplasty (TKA). METHOD: PubMed, Cochrane, Embase, Wanfang, CNKI, and VIP databases were searched by index words to identify the eligible RCTs; relevant literature sources were also searched. The latest research was conducted in March 2017. Relative risks (RR), mean difference (MD), and their corresponding 95% confidence intervals (95% CIs) were used to analyze the main outcomes. RESULT: A total of 22 articles were included in the meta-analysis with a total number of 11,320 patients (5543 in the LMWH group and 5777 in the control group). The results indicated that in the LMWH group, the incidence of DVT (OR: 0.57, 95% CI: 0.41-0.77) and wound complications (SMD: 0.96, 95% CI: 0.75-1.22) was significantly lower than that in the control group. Furthermore, LMWH also increased the occurrence of bleeding event (OR: 1.57, 95% CI: 1.31-1.88) and the total blood transfused (SMD: 0.12, 95% CI: 0.04-0.19). However, no statistical difference was found in blood loss (SMD: -0.26, 95% CI: -0.65-0.14) between the two group. In the subgroup analysis, the incidence of DVT was significantly decreased in the ardeparin sodium group (OR: 0.70, 95%CI: 0.53-0.94) and the dalteparin group (OR:0.40, 95%CI:0.32-0.50). CONCLUSION: Our meta-analysis demonstrated that LMWH is obviously efficacious in the prophylaxis of DVT after TKA. However, it has some negative effects, such as the increase in the number of bleeding events and the total blood transfused. SN - 1743-9159 UR - https://www.unboundmedicine.com/medline/citation/29733996/Low_molecular_weight_heparin_for_the_prevention_of_deep_venous_thrombosis_after_total_knee_arthroplasty:_A_systematic_review_and_meta-analysis L2 - https://linkinghub.elsevier.com/retrieve/pii/S1743-9191(18)30747-7 DB - PRIME DP - Unbound Medicine ER -