Table 25.
—[Section 2.5] Summary of Findings: IPCD Plus Anticoagulanta vs Anticoagulant for Major Orthopedic Surgeryb (Initial Prophylaxis Period Up to 14 Days)115,120
| Outcomes | No. of Participants (Studies) | Quality of the Evidence (GRADE) | Relative Effect (95% CI) | Anticipated Absolute
Effects |
|
| Risk With Anticoagulant | Risk Difference With IPCD + Anticoagulant (95% CI) | ||||
| Nonfatal PE |
667 (4 studies) |
Lowc,d due to
risk of bias and imprecision |
RR 0.96 (0.06-15) |
3 per 1,000 |
0 fewer per 1,000 (from 3 fewer to 40 more) |
| Symptomatic DVT (as inferred from asymptomatic
DVT) |
2470 (5 studies) |
Lowc,e due to risk of bias and
indirectness |
RR 0.26 (0.14-0.48) |
Study population |
|
| 50 per 1,000 | |||||
| Contemporary population (initial
prophylaxis)f | |||||
| 8 per 1,000 | 6 fewer per 1,000 (from 4 fewer to 7 fewer) | ||||
Anticoagulants used in both treatment and control groups: Borow et al,116 UFH or VKA; Bradley et al,117 UFH; Edwards et al,120 enoxaparin 30 mg bid; Eisele et al,118 certoparin 3,000 International Units/d; and Silbersack et al,119 enoxaparin 40 mg/d.
Borow et al116 included general surgery, orthopedics, gynecology, and vascular surgery patients; Bradley et al117 included THA; Edwards et al120 included THA and TKA patients; Eisele et al118 included total joint arthroplasty, knee surgery, tumor resection, open fixation of traumatic fractures, osteotomies, contusion injuries; and Silbersack120 included THA and TKA.
One study was quasi-randomized (Bradley et al117), and one study was classified as nonrandomized controlled clinical trial (Borow et al116). Randomization method was not clear in three trials (Edwards et al120; Eisele et al118; and Silbersack et al,119 which also did not provide enough information to judge allocation concealment). The personnel performing the DVT screening was not blinded in Eisele et al and likely not blinded in Edwards et al.
Only two events.
Mostly asymptomatic events.
Contemporary surgical population from which baseline risk of patient-important outcomes has been derived (contemporary era surgical technique, early mobilization, etc [see text for details on how baseline risks were calculated]).