Cochrane · systematic review · CD004179
Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
Forster, R, Stewart, M · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library
VascularAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
36
current version
GRADE rated
30
No studies
6
Included studies
NR
No studies 6 · 16.7%Ungraded 0 · 0%Very low 0 · 0%Low 15 · 41.7%Moderate 9 · 25%High 6 · 16.7%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Heparin compared to placebo for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
Population: people requiring prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE (DVT and PE) Treatment duration 28 ‐ 42 days Heparin vs placebo | OR 0.59 [0.35, 1.01] | 5 studies · 2329 participants | High |
Symptomatic DVT (proximal or distal) Treatment duration 28 ‐ 42 days Heparin vs placebo | OR 0.73 [0.39, 1.38] | 4 studies · 2019 participants | Moderate Downgraded: imprecision |
Symptomatic PE Treatment duration 28 ‐ 42 days Heparin vs placebo | OR 0.61 [0.16, 2.33] | 3 studies · 1595 participants | Low Downgraded: imprecision, inconsistency |
Bleeding ‐ major Treatment duration 28 ‐ 42 days Heparin vs placebo | OR 0.59 [0.14, 2.46] | 5 studies · 2500 participants | Moderate Downgraded: imprecision |
Clinically relevant non‐major bleeding Treatment duration 28 ‐ 42 days Heparin vs placebo | no estimate extracted | NR | No studies |
Bleeding ‐ minor Treatment duration 28 ‐ 42 days Heparin vs placebo | OR 2.01 [1.43, 2.81] | 5 studies · 2500 participants | High |
Vitamin K antagonists compared to placebo for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
Population: people requiring prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE (DVT and PE) Treatment duration 28 ‐ 42 days Vitamin K antagonists vs placebo | OR 0.1 [0.01, 1.94] | 1 study · 360 participants | Moderate Downgraded: imprecision, inconsistency |
Symptomatic DVT (proximal or distal) Treatment duration 28 ‐ 42 days Vitamin K antagonists vs placebo | OR 0.13 [0.01, 2.62] | 1 study · 360 participants | Moderate Downgraded: imprecision, inconsistency |
Symptomatic PE Treatment duration 28 ‐ 42 days Vitamin K antagonists vs placebo | OR 0.32 [0.01, 7.84] | 1 study · 360 participants | Moderate Downgraded: imprecision, inconsistency |
Bleeding ‐ major Treatment duration 28 ‐ 42 days Vitamin K antagonists vs placebo | OR 2.89 [0.12, 71.31] | 1 study · 360 participants | Low Downgraded: imprecision, inconsistency |
Clinically relevant non‐major bleeding Treatment duration 28 ‐ 42 days Vitamin K antagonists vs placebo | no estimate extracted | NR | No studies |
Minor bleeding Treatment duration 28 ‐ 42 days Vitamin K antagonists vs placebo | no estimate extracted | NR | No studies |
DOAC compared to placebo for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
Population: people requiring prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE (DVT and PE) Treatment duration 28 ‐ 42 days DOAC vs placebo | OR 0.2 [0.06, 0.68] | 1 study · 2419 participants | Moderate Downgraded: imprecision, inconsistency |
Symptomatic DVT (proximal or distal) Treatment duration 28 ‐ 42 days DOAC vs placebo | OR 0.18 [0.04, 0.81] | 2 studies · 2459 participants | High |
Symptomatic PE Treatment duration 28 ‐ 42 days DOAC vs placebo | OR 0.25 [0.03, 2.25] | 1 study · 1733 participants | Low Downgraded: imprecision, inconsistency |
Bleeding ‐ major Treatment duration 28 ‐ 42 days DOAC vs placebo | OR 1 [0.06, 16.02] | 1 study · 2457 participants | Low Downgraded: imprecision, inconsistency |
Bleeding‐ clinically relevant non‐major Treatment duration 28 ‐ 42 days DOAC vs placebo | OR 1.22 [0.76, 1.95] | 1 study · 2457 participants | Moderate Downgraded: imprecision, inconsistency |
Bleeding ‐ minor Treatment duration 28 ‐ 42 days DOAC vs placebo | OR 1.18 [0.74, 1.88] | 1 study · 2457 participants | Moderate Downgraded: imprecision, inconsistency |
Anticoagulants (chosen at investigators' discretion) compared to placebo for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
Population: people requiring prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE (DVT and PE) Treatment duration 28 ‐ 42 days Anticoagulants (chosen at investigators' discretion) vs placebo | OR 0.5 [0.09, 2.74] | 1 study · 557 participants | Low Downgraded: imprecision, inconsistency |
Symptomatic DVT (proximal or distal) Treatment duration 28 ‐ 42 days Anticoagulants (chosen at investigators' discretion) vs placebo | OR 0.33 [0.03, 3.21] | 1 study · 557 participants | Low Downgraded: imprecision, inconsistency |
Symptomatic PE Treatment duration 28 ‐ 42 days Anticoagulants (chosen at investigators' discretion) vs placebo | OR 1 [0.06, 16.13] | 1 study · 557 participants | Low Downgraded: imprecision, inconsistency |
Bleeding ‐ major Treatment duration 28 ‐ 42 days Anticoagulants (chosen at investigators' discretion) vs placebo | OR 5.05 [0.24, 105.76] | 1 study · 557 participants | Low Downgraded: imprecision, inconsistency |
Clinically relevant non‐major bleeding Treatment duration 28 ‐ 42 days Anticoagulants (chosen at investigators' discretion) vs placebo | no estimate extracted | NR | No studies |
Minor bleeding Treatment duration 28 ‐ 42 days Anticoagulants (chosen at investigators' discretion) vs placebo | no estimate extracted | NR | No studies |
Vitamin K antagonists compared to heparin for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
Population: people requiring prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE (DVT and PE) Treatment duration 28 ‐ 42 days Vitamin K antagonists vs heparin | OR 1.64 [0.85, 3.16] | 1 study · 1279 participants | Low Downgraded: imprecision, inconsistency |
Symptomatic DVT (proximal or distal) Treatment duration 28 ‐ 42 days Vitamin K antagonists vs heparin | OR 1.36 [0.69, 2.68] | 1 study · 1279 participants | Low Downgraded: imprecision, inconsistency |
Symptomatic PE Treatment duration 28 ‐ 42 days Vitamin K antagonists vs heparin | OR 9.16 [0.49, 170.42] | 1 study · 1279 participants | Low Downgraded: imprecision, inconsistency |
Bleeding ‐ major Treatment duration 28 ‐ 42 days Vitamin K antagonists vs heparin | OR 3.87 [1.91, 7.85] | 1 study · 1272 participants | Low Downgraded: imprecision, inconsistency |
Bleeding ‐ clinically indicated non‐major Treatment duration 28 ‐ 42 days Vitamin K antagonists vs heparin | no estimate extracted | NR | No studies |
Bleeding ‐ minor Treatment duration 28 ‐ 42 days Vitamin K antagonists vs heparin | OR 1.33 [0.64, 2.76] | 1 study · 1279 participants | Low Downgraded: imprecision, inconsistency |
DOAC compared to heparin for people requiring prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
Population: people requiring prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE (DVT and PE) Treatment duration 28 ‐ 42 days DOAC vs heparin | OR 0.7 [0.28, 1.7] | 5 studies · 15977 participants | Low Downgraded: imprecision, inconsistency |
Symptomatic DVT (proximal or distal) Treatment duration 28 ‐ 42 days DOAC vs heparin | OR 0.6 [0.11, 3.27] | 5 studies · 15977 participants | Low Downgraded: imprecision, inconsistency |
Symptomatic PE Treatment duration 28 ‐ 42 days DOAC vs heparin | OR 0.91 [0.43, 1.94] | 5 studies · 14731 participants | Moderate Downgraded: imprecision |
Bleeding ‐ major Treatment duration 28 ‐ 42 days DOAC vs heparin | OR 1.11 [0.79, 1.54] | 5 studies · 16199 participants | High |
Bleeding ‐ clinically relevant, non‐major Treatment duration 28 ‐ 42 days DOAC vs heparin | OR 1.08 [0.9, 1.28] | 4 studies · 15241 participants | High |
Bleeding ‐ minor Treatment duration 28 ‐ 42 days DOAC vs heparin | OR 0.95 [0.82, 1.1] | 4 studies · 11766 participants | High |