Prevention of Venous Thromboembolism in Major Orthopedic Surgery: Bayesian Network Meta-Analysis of 21 Randomized Trials Evaluating Unfractionated Heparins, Low-Molecular Weight Heparins, and New Oral Anticoagulants

authors:

avatar Andrea Messori 1 , * , avatar Sabrina Trippoli 1 , avatar Dario Maratea 1 , avatar Valeria Fadda 1 , avatar Claudio Marinai 2

HTA Unit, ESTAR, Regional Health Service, Firenze, Italy
Department of Pharmaceutical Logistics, ESTAR, Regional Health Service, Firenze, Italy
International Cardiovascular Research Journal: Vol.9, issue 4; e10966
published online: December 31, 2015
article type: Brief Report
received: January 02, 2015
revised: April 05, 2015
accepted: April 21, 2015
DOI: https://doi.org/10.17795/icrj-9(4)238

how to cite: Messori A, Trippoli S, Maratea D, Fadda V, Marinai C. Prevention of Venous Thromboembolism in Major Orthopedic Surgery: Bayesian Network Meta-Analysis of 21 Randomized Trials Evaluating Unfractionated Heparins, Low-Molecular Weight Heparins, and New Oral Anticoagulants. Int Cardiovasc Res J. 2015;9(4):e10966. https://doi.org/10.17795/icrj-9(4)238.

Abstract

Background: In major orthopedic surgery, prevention of venous thromboembolism has been based on Unfractionated Heparins (UFHs) over the past decades, then on Low-Molecular Weight Heparins (LMWHs), and on New Oral Anticoagulants (NOACs) more recently. To summarize the comparative effectiveness of UFHs, LMWHs, and NOACs in this clinical indication, we applied Bayesian network meta-analysis to the clinical material (randomized studies) published in two previous reviews focused on this issue.
Objectives: Our end-point was a composite of venous thromboembolism and pulmonary embolism.
Materials and Methods: Our analysis was based on standard Bayesian network meta-analysis (random-effect model).
Results: The analysis included 21 randomized trials for a total of 21,805 patients. Our results showed that the degree of effectiveness did not differ among UFHs, LMWHs, and NOACs. Although some trends emerged from an in-depth analysis of these data (e.g. according to the histogram of rankings), no significant differences were found (P > 0.05). Moreover, two agents among LMWHs proved to be adequately supported by randomized trials (enoxaparin and dalteparin), while limited evidence was available for other agents of this class.
Conclusions: Our synthesis of the effectiveness data can be useful as an overall reference in this area and can also contribute to defining the place of further innovative treatments for this clinical indication.

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References

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