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Summary Background There are numerous trials and several meta-analyses comparing venous thromboembolism (VTE) prophylaxis options after total hip and knee replacement (THR and TKR). None prior included simultaneous comparison of new with older options. Objective To measure simultaneously the relative risk of VTE and hemorrhage for 12 prophylaxis options. Methods We abstracted VTE and hemorrhage information from randomized controlled trials published between January 1990 and June 2016 comparing 12 prophylaxis options. We then constructed networks to compute relative risk for each option relative to low molecular weight heparin at once daily dosing (LMWH Low). Results Main Relative to LMWH Low, direct oral Xa inhibitors had the lowest risk of total DVT - asymptomatic and symptomatic (OR 0.45 95% CI 0.35-0.57) translating to 53 to 139 fewer DVTs per 1000 patients. VKAs titrated to INR 2-3 predicted 56% more DVT events (OR 1.56 95% CI 1.14-2.14). Aspirin performed similarly (OR 0.80 95% CI 0.34-1.86) although small numbers prohibit firm conclusions. direct oral Xa inhibitors did not lead to significantly more bleeding (OR 1.21 95% CI 0.79-1.90). Secondary Relative to LMWH Low, direct oral Xa inhibitors prevented fourfold more symptomatic DVTs (OR 0.25 95% CI 0.13-0.47). Conclusions Relative to LMWH Low, direct oral Xa inhibitors had a more favorable profile of VTE and hemorrhage risk whereas VKAs had a less favorable profile. The profile of other agents was not more or less favorable. Clinicians should consider these profiles when selecting prophylaxis options.

Topical TCC is an effective stimulant of healing of ischemic open wounds in rats and may have an application for the treatment of chronic wounds in other species. Clinical evaluation of topical TCC is warranted.