Preoperative vs postoperative initiation of low-molecular-weight heparin prophylaxis against venous thromboembolism in patients undergoing elective hip replacement.
Although preoperative and postoperative initiation of prophylaxis for deep vein thrombosis (DVT) with low-molecular-weight heparin (LMWH) are effective, the relative effectiveness and safety of these approaches is unknown.
In the absence of a published definitive level 1 trial addressing this question, a meta-analysis is appropriate.
To report a meta-analysis comparing preoperative with postoperative initiation of prophylaxis of DVT in patients undergoing elective hip replacement.
Relevant trials were identified, and potential biases in the meta-analysis were minimized by analyzing all rigorously performed randomized trials that met all of the following criteria for conduct of the trial : (1) double-blind design, (2) objective documentation of the frequencies of DVT by ascending contrast venography, (3) venography performed before or at the time of discharge from the hospital, (4) initiation of the same LMWH preoperatively or postoperatively in dosages shown to be effective, (5) compliance with the criteria for a level 1 trial, and (6) objective documentation of major and minor bleeding according to strict criteria.
Treatment with LMWH initiated preoperatively was associated with a DVT frequency of 10.0% compared with a frequency of 15.3% when the LMWH was initiated postoperatively (P=02, Fisher exact test). (...)
Mots-clés Pascal : Hanche, Electif, Prothèse, Héparine bas poids moléculaire, Essai thérapeutique contrôlé, Préopératoire, Thrombose, Veine profonde, Postopératoire, Prévention, Etude comparative, Métaanalyse, Analyse statistique, Homme, Système ostéoarticulaire pathologie, Chirurgie, Anticoagulant, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Veine pathologie
Mots-clés Pascal anglais : Hip, Elective, Prosthesis, Low molecular weight heparin, Controlled therapeutic trial, Preoperative, Thrombosis, Deep vein, Postoperative, Prevention, Comparative study, Metaanalysis, Statistical analysis, Human, Diseases of the osteoarticular system, Surgery, Anticoagulant, Cardiovascular disease, Vascular disease, Venous disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0107879
Code Inist : 002B02G. Création : 16/11/1999.