AHRQ: Review of VTE prophylaxis in orthopedic surgery

Editor's Note

A new report from the Agency for Healthcare Research and Quality (AHRQ) compares the effectiveness of strategies to prevent venous thromboembolism (VTE) in patients having total hip replacement (THR), total knee replacement (TKR), or hip fracture surgery.

The study directly compares different types of blood thinners and mechanical interventions. The findings include:

• In THR, low molecular weight heparin (LMWH) had lower VTE and adverse event risks than unfractionated heparin; LMWH and aspirin had similar risks of VTE and major bleeding; direct thrombin inhibitors (DTI) had lower DVT risks than LMWH but higher bleeding risks; and higher dose LMWH had lower DVT risks but higher bleeding risks than lower dose.
• In TKR, vitamin K antagonists (VKA) had higher DVT risks than LMWH but lower bleeding risks, and higher dose DTI had lower DVT risks but higher bleeding risks than lower dose.
• In hip fracture surgery and other interventions, there was insufficient evidence to assess benefit and harm, or findings were inconsistent.

The authors concluded that more research is needed to determine the most effective strategy for preventing VTE after total hip or knee replacement and hip fracture surgery.

Research Review - Final - Jun. 22, 2017 Formats These reports are available in PDF only ( final report [7.4 MB]; executive summary [279 kB]). People using assistive technology may not be able to fully access information in these files. For additional assistance, please contact us.