EQUIVALENCE OF DOACS AND LMWH FOR THROMBOPROPHYLAXIS AFTER HIP FRACTURE SURGERY: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background Patients with hip fractures (HF) have an increased risk of venous thromboembolism (VTE). In elective orthopedic surgery direct oral anticoagulants (DOACs) have proven to be similarly or more effective compared to low molecular weight heparin (LMWH), but DOACs are not yet approved for thromboprophylaxis in trauma patients with HF. The aim of this study was to systematically review the literature comparing the effectiveness of DOACs and LMWH for thromboprophylaxis in trauma patients with surgically treated HF. Materials and Methods We searched PubMed, the Cochrane Library, Web of Science, and Embase. The primary outcome was the incidence of VTE (symptomatic and asymptomatic combined). Secondary outcomes were symptomatic VTE; a symptomatic VTE, symptomatic deep venous thrombosis (DVT); symptomatic pulmonary embolism (PE); major, clinically relevant non-major (CRNM), and minor bleeding. Meta-analysis was performed to compare the odds of VTE and secondary outcomes between DOACs and LMWH. Results The search resulted in 738 titles. Five studies matched inclusion criteria. In total, 4,748 hip fracture patients were analyzed (DOACs: 2,276 patients, LMWH: 2,472 patients). The pooled odds ratio for the risk of VTE for DOAC use was 0.52 (95% confidence interval 0.25 – 1.07, p=0.08) compared to LMWH. No statistically significant differences between DOAC and LMWH were found for asymptomatic VTE, symptomatic DVT, PE, major or CRNM bleeding, and minor bleeding. Conclusions Meta-analysis of the literature suggests that DOACs are associated with equivalent effectiveness and safety compared to LMWH.