{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:04:20Z","timestamp":1762430660119,"version":"build-2065373602"},"reference-count":45,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2012,6,28]],"date-time":"2012-06-28T00:00:00Z","timestamp":1340841600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2012,9]]},"abstract":"Study Objective<\/jats:title>To evaluate the comparative efficacy and safety of low\u2010molecular\u2010weight heparins (LMWHs<\/jats:styled-content>) versus other anticoagulants as venous thromboembolism<\/jats:styled-content> prophylaxis in major orthopedic surgery.<\/jats:p><\/jats:sec>Design<\/jats:title>Systematic review with meta\u2010analysis of 37 randomized controlled trials.<\/jats:p><\/jats:sec>Patients<\/jats:title>Patients undergoing total hip replacement, total knee replacement, or hip fracture surgery who received prophylaxis with a LMWH or another anticoagulant.<\/jats:p><\/jats:sec>Measurements and Main Results<\/jats:title>We conducted a systematic literature search of the MEDLINE, Cochrane Central Register of Controlled Trials, and Scopus databases (1980\u2013J<\/jats:styled-content>uly 2011) to identify randomized controlled trials. Trials were included if they directly compared LMWH<\/jats:styled-content> prophylaxis with another anticoagulant class and reported outcomes of interest. Compared with patients who received unfractionated heparin (UFH<\/jats:styled-content>), patients who received LMWH<\/jats:styled-content>s had fewer pulmonary embolism,<\/jats:styled-content> total deep vein thrombosis (DVT)<\/jats:styled-content>, major bleeding, and heparin\u2010induced thrombocytopenia events. Compared with patients who received vitamin K<\/jats:styled-content> antagonists (VKA<\/jats:styled-content>s), patients who received LMWH<\/jats:styled-content>s had fewer total DVT<\/jats:styled-content> and distal DVT<\/jats:styled-content> events but reported increased major bleeding, minor bleeding, and surgical site bleeding events. Major efficacy end points such as symptomatic venous thromboembolism<\/jats:styled-content>, pulmonary embolism<\/jats:styled-content>, and nonfatal pulmonary embolism<\/jats:styled-content> showed similar benefits of therapy with LMWH<\/jats:styled-content>s and VKA<\/jats:styled-content>s. Compared with patients receiving factor X<\/jats:styled-content>a inhibitors, patients who received LMWH<\/jats:styled-content>s had more major venous thromboembolism<\/jats:styled-content>, pulmonary embolism<\/jats:styled-content>, total DVT<\/jats:styled-content>, asymptomatic DVT<\/jats:styled-content>, proximal DVT<\/jats:styled-content>, and distal DVT<\/jats:styled-content> events but fewer major bleeding events. Compared with patients receiving direct thrombin inhibitors (DTI<\/jats:styled-content>s), patients who received LMWH<\/jats:styled-content>s had more major venous thromboembolism<\/jats:styled-content>, total DVT<\/jats:styled-content>, and proximal DVT<\/jats:styled-content> events without significantly negatively affecting bleeding. However, patients who received LMWH<\/jats:styled-content>s had fewer distal DVT<\/jats:styled-content> events versus those who received DTI<\/jats:styled-content>s. Subgroup analyses indicated differences based on the surgical procedure and individual drug within certain pharmacologic classes.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>According to moderate\u2010to\u2010high strength of evidence, LMWH<\/jats:styled-content> prophylaxis provides additional benefits with less harm compared with UFH<\/jats:styled-content>. With predominantly moderate strength of evidence, the balance of benefits to harms for factor X<\/jats:styled-content>a inhibitors or DTI<\/jats:styled-content>s compared with LMWH<\/jats:styled-content>s seems favorable. With predominantly low\u2010to\u2010moderate strength of evidence, the known benefits in total DVT<\/jats:styled-content> and distal DVT<\/jats:styled-content> with LMWH<\/jats:styled-content>s versus VKA<\/jats:styled-content>s may not be sufficient to counteract the increased risk of bleeding.<\/jats:p><\/jats:sec>","DOI":"10.1002\/j.1875-9114.2012.01106.x","type":"journal-article","created":{"date-parts":[[2012,9,4]],"date-time":"2012-09-04T08:25:48Z","timestamp":1346747148000},"page":"799-808","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Comparative Effectiveness of Low\u2010Molecular\u2010Weight Heparins versus Other Anticoagulants in Major Orthopedic Surgery: A Systematic Review and Meta\u2010analysis"],"prefix":"10.1002","volume":"32","author":[{"given":"Diana M.","family":"Sobieraj","sequence":"first","affiliation":[{"name":"University of Connecticut\/Hartford Hospital Evidence\u2010Based Practice Center Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig I.","family":"Coleman","sequence":"additional","affiliation":[{"name":"University of Connecticut\/Hartford Hospital Evidence\u2010Based Practice Center Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanita","family":"Tongbram","sequence":"additional","affiliation":[{"name":"University of Connecticut\/Hartford Hospital Evidence\u2010Based Practice Center Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Chen","sequence":"additional","affiliation":[{"name":"University of Connecticut\/Hartford Hospital Evidence\u2010Based Practice Center Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Colby","sequence":"additional","affiliation":[{"name":"University of Connecticut\/Hartford Hospital Evidence\u2010Based Practice Center Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soyon","family":"Lee","sequence":"additional","affiliation":[{"name":"University of Connecticut\/Hartford Hospital Evidence\u2010Based Practice Center Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Kluger","sequence":"additional","affiliation":[{"name":"University of Connecticut\/Hartford Hospital Evidence\u2010Based Practice Center Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sagar","family":"Makanji","sequence":"additional","affiliation":[{"name":"University of Connecticut\/Hartford Hospital Evidence\u2010Based Practice Center Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajibade","family":"Ashaye","sequence":"additional","affiliation":[{"name":"University of Connecticut\/Hartford Hospital Evidence\u2010Based Practice Center Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. 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