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From the same journal

Venous thromboembolism prophylaxis strategies for people undergoing elective total hip replacement: a systematic review and network meta-analysis

Research output: Contribution to journalArticle

Published copy (DOI)


  • Sedina Lewis
  • Jessica Glen
  • Dalia Dawoud
  • Sofia Dias
  • Jill Cobb
  • Xavier Griffin
  • Michael Reed
  • Carlos Sharpin
  • Gerard Stansby
  • Peter Barry


Publication details

JournalValue in Health
DateAccepted/In press - 20 Feb 2019
DateE-pub ahead of print - 17 May 2019
DatePublished (current) - 1 Aug 2019
Issue number8
Pages (from-to)953-969
Early online date17/05/19
Original languageEnglish


Objectives: To assess the efficacy and safety of venous thromboembolism prophylaxis in people undergoing elective total hip replacement. Methods: Systematic review and Bayesian network meta-analyses of randomized controlled trials were conducted for 3 outcomes: deep vein thrombosis (DVT), pulmonary embolism (PE), and major bleeding (MB). MEDLINE, EMBASE, and Cochrane Library (CENTRAL) databases were searched. Study quality was assessed using the Cochrane risk-of-bias checklist. Fixed- and random-effects models were fitted and compared. The median relative risk (RR) and odds ratio (OR) compared with no prophylaxis, with their 95% credible intervals (CrIs), rank, and probability of being the best, were calculated. Results: Forty-two (n = 24 374, 26 interventions), 30 (n = 28 842, 23 interventions), and 24 (n = 31 792, 15 interventions) randomized controlled trials were included in the DVT, PE, and MB networks, respectively. Rivaroxaban had the highest probability of being the most effective intervention for DVT (RR 0.06 [95% CrI 0.01-0.29]). Strategy of low-molecular-weight heparin followed by aspirin had the highest probability of reducing the risk of PE and MB (RR 0.0011 [95% CrI 0.00-0.096] and OR 0.37 [95% CrI 0.00-26.96], respectively). The ranking of efficacy estimates across the 3 networks, particularly PE and MB, had very wide CrIs, indicating high degree of uncertainty. Conclusions: A strategy of low-molecular-weight heparin given for 10 days followed by aspirin for 28 days had the best benefit-risk balance, with the highest probability of being the best on the basis of the results of the PE and MB network meta-analyses. Nevertheless, there is considerable uncertainty around the median ranks of the interventions.

Bibliographical note

© 2019 ISPOR-The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy.

    Research areas

  • deep vein thrombosis, direct-acting oral anticoagulants, hospital-acquired thrombosis, network meta-analysis, orthopedics, pulmonary embolism, systematic review, total hip replacement, venous thromboembolism

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