• Guangwei Sun, Jingjing Wu, Qian Wang, Qiang Liang, Jian Jia, Kai Cheng, Guoliang Sun, and Zili Wang.
• Department of Orthopaedics, General Hospital of Ningxia Medical University, Xingqing District, Yinchuan City, People's Republic of China; Department of Orthopaedics, Linfen People's Hospital, Linfen City, People's Republic of China.
• J Arthroplasty. 2019 Apr 1; 34 (4): 789-800.e6.

BackgroundThe purpose of this study is to perform a meta-analysis to compare outcomes of venous thromboembolism (VTE) prophylaxis with low-molecular-weight heparin (LMWH) vs other anticoagulants in patients who received total knee (TKA) or total hip arthroplasty (THA).MethodsMEDLINE, Cochrane, EMBASE, and Google Scholar databases were searched until June 30, 2017 for eligible randomized controlled studies.ResultsThirty-two randomized controlled studies were included. LMWH provided better protection against VTE than placebo. In both TKA and THA patients, the rates of VTE were lower with factor Xa inhibitors than LMWH. In THA patients, the rate of deep vein thrombosis (DVT) was lower with factor Xa inhibitors than LMWH. In TKA patients, the rates of VTE and DVT were similar between LMWH and direct thrombin inhibitors. In THA patients, the rate of VTE was lower with direct thrombin inhibitors than with LMWH, while the DVT rates were similar. The pulmonary embolism rates were similar between all 3 classes of drugs in TKA and THR patients, as were the major bleeding rates. Nonmajor and minor bleeding rates were also similar between the 3 drug classes.ConclusionLMWH is associated with a higher rate of VTE than factor Xa inhibitors in TKA and THA patients. Direct thrombin inhibitors are associated with a lower rate of VTE in THA patients, but their effectiveness with respect to DVT and pulmonary embolism prophylaxis is similar to that of LMWH in TKA and THA patients.Copyright © 2018. Published by Elsevier Inc.

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