A comparison of the efficacy and safety of direct oral anticoagulants with low molecular weight heparin for venous thromboembolism prophylaxis after total hip arthroplasty : a systematic review and meta-analysis.
Hasan R Mohammad, Azmi Rahman, Ibrahim M Muhammad et al.
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In 30 seconds
This systematic review and meta-analysis compared direct oral anticoagulants (DOACs) with low molecular weight heparin (LMWH) for venous thromboembolism prophylaxis after elective total hip arthroplasty. It included 22 randomised controlled trials involving 28,112 participants. Overall, DOACs were associated with lower VTE risk than LMWH (OR 0.62 (95% CI 0.47 to 0.82); p = 0.002), driven by fewer deep vein thromboses. Overall bleeding risk was higher with DOACs, but this difference was not seen when analyses were restricted to UK-licensed agents and doses. Reoperation and mortality risks did not differ.
Key findings
- VTE risk was lower with DOACs than LMWH (OR 0.62 (95% CI 0.47 to 0.82); p = 0.002), driven by reduced DVT risk (OR 0.60 (95% CI 0.42 to 0.86); p = 0.008).
- Overall bleeding risk was higher with DOACs (OR 1.19 (95% CI 1.03 to 1.38); p = 0.023); for UK-licensed agents and doses, there was no difference (OR 1.06 (95% CI 0.95 to 1.18); p = 0.279).
- Reoperation risk (OR 1.21 (95% CI 0.75 to 1.93); p = 0.351) and mortality (OR 1.03 (95% CI 0.46 to 2.33); p = 0.937) did not differ between groups.
Why it matters
VTE prevention after elective hip replacement requires balancing thrombotic protection against bleeding. These pooled trial findings suggest that DOACs may reduce VTE, particularly DVT, compared with LMWH, while the bleeding signal depends on the agents and doses considered. The results help frame that benefit–risk comparison, but do not establish that every DOAC regimen has the same safety profile.
What to keep in mind
The review identifies a need for new trials comparing UK-licensed DOACs and LMWH alongside modern postoperative rehabilitation protocols.