PMID- 37936980
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231127
IS  - 2472-7245 (Electronic)
IS  - 2472-7245 (Linking)
VI  - 8
IP  - 4
DP  - 2023 Oct-Dec
TI  - Effectiveness of Thromboprophylaxis Agents Following Hip Fracture: A Systematic 
      Review and Network Meta-Analysis.
LID - 10.2106/JBJS.OA.23.00064 [doi]
LID - e23.00064
AB  - BACKGROUND: Multiple studies have compared different pharmacologic 
      thromboprophylaxis agents after hip fracture surgery, including aspirin, 
      unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), direct oral 
      anticoagulants (DOAC), and warfarin, resulting in variability in clinical 
      practice. To guide clinical management, a systematic review and network 
      meta-analysis (NMA), which enables the simultaneous assessment of the effects of 
      multiple interventions for the same patient population, was performed. This study 
      aimed to determine the comparative effectiveness of thromboprophylaxis in 
      reducing venous thromboembolism (VTE) in patients with surgically treated hip 
      fractures. METHODS: The primary outcome was the effect of the treatment on the 
      VTE rate, and the secondary outcome was the treatment effect on the bleeding 
      rate. Relevant studies were identified by a systematic search of Embase, MEDLINE, 
      and the Cochrane Central Register of Controlled Trials (CENTRAL) from January 
      2000 to February 2022. Title, abstract, and full-text screening; data extraction; 
      and risk-of-bias assessment were performed. All studies examining 
      thromboprophylaxis interventions (DOAC, LMWH, UFH, aspirin, and warfarin) in 
      patients with a surgically treated hip fracture were included. Bayesian NMA was 
      performed, and dichotomous outcome data were pooled using the odds ratio. 
      Interventions were ranked using the surface under the cumulative ranking curve 
      (SUCRA) for each outcome. RESULTS: A total of 19 studies were included after the 
      screening of 466 citations and 77 full-text articles. Of the included studies, 15 
      studies had a high overall risk of bias. The NMA of the VTE outcome included 19 
      studies, 49,409 participants, and 6 thromboprophylaxis interventions. The NMA of 
      the bleeding outcome included 3 studies, 18,163 participants, and 3 
      interventions. The mean age ranged from 43.5 to 86.2 years among the included 
      studies. No thromboprophylaxis intervention was statistically different from any 
      other intervention in its effect on the VTE or bleeding rate in hip fracture 
      patients. CONCLUSIONS: This NMA demonstrated that there was no difference between 
      the thromboprophylaxis interventions in reducing VTE or bleeding rates in hip 
      fracture patients. More robust randomized controlled trials are needed to 
      determine the most effective thromboprophylaxis interventions for patients with 
      hip fractures. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for 
      Authors for a complete description of levels of evidence.
CI  - Copyright (c) 2023 The Authors. Published by The Journal of Bone and Joint Surgery, 
      Incorporated. All rights reserved.
FAU - Negm, Ahmed M
AU  - Negm AM
AD  - Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
FAU - Yamaura, Lisa
AU  - Yamaura L
AD  - Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
FAU - Clarke, Ashley
AU  - Clarke A
AD  - Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
FAU - Chaudhry, Daniyya
AU  - Chaudhry D
AD  - Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
FAU - Cherppukaran, Tanya
AU  - Cherppukaran T
AD  - Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
FAU - Schneider, Prism
AU  - Schneider P
AD  - Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
LA  - eng
PT  - Journal Article
DEP - 20231107
PL  - United States
TA  - JB JS Open Access
JT  - JB & JS open access
JID - 101726219
PMC - PMC10624462
COIS- Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided 
      with the online version of the article (http://links.lww.com/JBJSOA/A570).
EDAT- 2023/11/08 06:44
MHDA- 2023/11/08 06:45
PMCR- 2023/11/07
CRDT- 2023/11/08 03:58
PHST- 2023/11/08 06:45 [medline]
PHST- 2023/11/08 06:44 [pubmed]
PHST- 2023/11/08 03:58 [entrez]
PHST- 2023/11/07 00:00 [pmc-release]
AID - JBJSOA-D-23-00064 [pii]
AID - 10.2106/JBJS.OA.23.00064 [doi]
PST - epublish
SO  - JB JS Open Access. 2023 Nov 7;8(4):e23.00064. doi: 10.2106/JBJS.OA.23.00064. 
      eCollection 2023 Oct-Dec.