Thromboprophylaxis and Bleeding Complications in Orthopedic and Trauma Patients: A Systematic Review

Joseph V. Villarreal, Naohiro Shibuya, Daniel C. Jupiter

    Research output: Contribution to journalReview articlepeer-review

    2 Scopus citations

    Abstract

    This systematic review was conducted to investigate the effects of currently used chemoprophylactic modalities to assess concerns regarding their usage. Preventive benefits of thromboprophylaxis were weighed against potential complications in orthopedic and trauma patients. The Ovid MEDLINE® database was used to identify relevant studies. The authors independently screened the initial study articles by title and abstract, eliminating articles not dealing with venous thromboembolism (VTE) chemoprophylaxis in orthopedic or trauma populations. The remaining articles were assessed for eligibility through full-text analysis. The analyzed studies within this review suggested that Factor Xa inhibitors and direct oral anticoagulants hold promise as safe and potentially more effective thromboprophylactic entities when compared to low molecular weight heparin in trauma and orthopedic patients. Thromboprophylaxis had little to no effect on major bleeding incidence, although we could not definitively conclude there was no effect on overall bleeding. Early thromboprophylaxis, especially when identifiable risk factors are present, can improve VTE prevention without changing major bleeding rates. Additionally, we could not conclude whether extended prophylaxis affects VTE incidence, although it seemed to have no effect on major bleeding. Finally, we determined that thromboprophylaxis in the lower extremity trauma population is questionable without the presence of underlying risk factors.

    Original languageEnglish (US)
    Pages (from-to)1014-1022
    Number of pages9
    JournalJournal of Foot and Ankle Surgery
    Volume60
    Issue number5
    DOIs
    StatePublished - Sep 1 2021

    Keywords

    • 2
    • bleeding complications
    • hypercoagulability
    • orthopedic trauma
    • thromboprophylaxis
    • venous thromboembolism

    ASJC Scopus subject areas

    • Surgery
    • Orthopedics and Sports Medicine

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