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<p>Clinical practice guidelines on the optimal thromboprophylaxis duration following total hip and knee arthroplasty (THA and TKA) and hip fracture surgery are inconsistent. The aim of this meta-analysis is to investigate the effect of pharmacological prophylaxis duration on postoperative venous thromboembolism (VTE) in these patients. The primary outcome was the incidence of symptomatic and confirmed VTE at three months following surgery. A systematic search was performed in MEDLINE Complete (EBSCO), Embase, CINAHL complete (EBSCO), Web of Science and in CENTRAL databases, for randomised controlled trials comparing extended (minimum 28 days for THA and 10 days for TKA) vs. shorter duration thromboprophylaxis or placebo following these operations. Fifteen trials with a total of 26,580 participants were identified. Compared to shorter prophylaxis, extended thromboprophylaxis reduced 90-day symptomatic and confirmed VTE (OR: 0.43; 95% CI: 0.26–0.72; <i>P</i> = 0.001, I<sup>2</sup> = 0%; <i>P</i> = 0.75, respectively), significant only in the THA subgroup (<i>P</i> = 0.002). Beneficial effects were also observed with 30-day deep venous thrombosis (DVT) (OR: 0.32; 95% CI: 0.20–0.50; <i>P</i> &lt; 0.001) and proximal DVT incidence (OR: 0.22; 95% CI: 0.12–0.41; <i>P</i> &lt; 0.001) following THA. There were insufficient data to support extended prophylaxis for hip fracture surgery or TKA. Extending thromboprophylaxis up to 25–35 days appeared to reduce the incidence of 90-day symptomatic and confirmed VTE, particularly after THA. However, contemporary perioperative protocols, including early mobilisation and risk stratification, must be considered in determining optimal prophylaxis duration.</p> Graphical Abstract <p></p>

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Impact of extended duration pharmacological thromboprophylaxis on venous thromboembolism after hip and knee arthroplasty and hip fracture surgery: a systematic review and meta-analysis of randomised controlled trials

  • 期刊论文

  • 发表日期：

    2025年12月9日

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  • Usha Gurunathan,
  • Matthew Bright,
  • Daniel Mullany,
  • Mathew Judd,
  • Karen Hay,
  • Harshal Nandurkar,
  • Victoria Eley

摘要

Clinical practice guidelines on the optimal thromboprophylaxis duration following total hip and knee arthroplasty (THA and TKA) and hip fracture surgery are inconsistent. The aim of this meta-analysis is to investigate the effect of pharmacological prophylaxis duration on postoperative venous thromboembolism (VTE) in these patients. The primary outcome was the incidence of symptomatic and confirmed VTE at three months following surgery. A systematic search was performed in MEDLINE Complete (EBSCO), Embase, CINAHL complete (EBSCO), Web of Science and in CENTRAL databases, for randomised controlled trials comparing extended (minimum 28 days for THA and 10 days for TKA) vs. shorter duration thromboprophylaxis or placebo following these operations. Fifteen trials with a total of 26,580 participants were identified. Compared to shorter prophylaxis, extended thromboprophylaxis reduced 90-day symptomatic and confirmed VTE (OR: 0.43; 95% CI: 0.26–0.72; P = 0.001, I2 = 0%; P = 0.75, respectively), significant only in the THA subgroup (P = 0.002). Beneficial effects were also observed with 30-day deep venous thrombosis (DVT) (OR: 0.32; 95% CI: 0.20–0.50; P < 0.001) and proximal DVT incidence (OR: 0.22; 95% CI: 0.12–0.41; P < 0.001) following THA. There were insufficient data to support extended prophylaxis for hip fracture surgery or TKA. Extending thromboprophylaxis up to 25–35 days appeared to reduce the incidence of 90-day symptomatic and confirmed VTE, particularly after THA. However, contemporary perioperative protocols, including early mobilisation and risk stratification, must be considered in determining optimal prophylaxis duration.

Graphical Abstract