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Mechanical Prophylaxis Compared with Low-molecular-weight Heparins for Preventing Venous Thrombosis after Orthopedic Surgery: A Systematic and Meta-analysis
J. Kor. Soc. Health-syst. Pharm. 2018;35:254-267
Published online August 31, 2018
© 2018 Korean Society of Health-System Pharmacists

Xing-xian Luoa, Jun-ping Hana, Muhammad Usmana, Charles D. Sandsb and Chang-qing Yanga,†

School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Jiangsu, Chinaa
McWhorter School of Pharmacy, Samford University, Alabama, USAb
Correspondence to: Chang-qing Yang, Tel:(86)-15005179447 E-mail:ycq0315@yahoo.com
Received September 11, 2017; Revised November 6, 2017; Accepted June 22, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background : Mechanical prophylaxis (MP) and low-molecular-weight heparins (LMWHs) have been widely used after patient undergoing orthopedic surgery. However, their efficacy in preventing venous thrombus remains unclear.
Methods : PubMed, Embase and Cochrane library databases were systematically searched for studies that investigated the effectiveness between MP and LMWHs. Predefined outcomes were incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), proximal DVT and major bleeding using random-effects models.
Results : A total of 8 randomized controlled trials (RCTs) on 2899 patients were eligible for inclusion. No significant difference was observed between MP and LMWHs for the prevention of DVT (RR 1.37; 95% CI: 0.83-2.26), PE (RR 1.35; 95% CI: 0.41-4.41), or proximal DVT (RR 1.30; 95% CI: 0.55-3.02). However, there was a significant reduction of major bleeding (RR 0.21; 95% CI: 0.05-0.82). Predefined subgroup analysis suggested that MP might enhance the occurrence of DVT in comparison with fixed-dose LMWHs (RR 1.61; 95% CI: 1.09-2.37), but not in the subgroup with adjusted-weight LMWHs (RR 0.38; 95% CI, 0.11-1.30). Without combining graduated compression stockings (GCS) in both groups, the incidence of DVT was significantly associated with MP (RR 1.88; 95% CI: 1.01-3.21).
Conclusions : Results of this meta-analysis suggested, compared to LMWHs, MP might have no significance in the prevention of DVT, although it was associated with lower incidence of major bleeding after patients underwent orthopedic surgery. However, subgroup analyses suggested that fixed-based LMWHs or application one of mechanical types without GCS might have differential
effects. Therefore, large-scaled and well-designed RCTs are needed in the future.
Keywords : Low-molecular-weight heparins, Mechanical prophylaxis, Orthopedic surgery, Deep vein thrombosis, Arthroplasty


November 2018, 35 (4)