Overall rate of adverse events as well as in-hospital hip dislocations, oliguria and non-adherence to VTE prophylaxis protocols were significantly reduced during the second period. We conclude that clinical pathways alone are insufficient to improve patient safety and require prospective monitoring and continuous feedback to health care providers in order to achieve the desired effect.

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set out to establish the first standards for heparin use. 1 In 1947, in Toronto, Gordon Murray 4 used clinical trials to determine the heparin doses necessary to prevent thrombosis in severe injuries. With these investigations, the era of thrombolysis began. In the subsequent 72 years, new products have been developed, and the types of low-molecularweight heparin (LMWH) currently used most widely around the world are enoxaparin, nadroparin, and dalteparin sodium. To this day, controversy surrounding LMWH continues. 6 Studies have examined the effects and safety of LMWH in arthroscopic surgery, particularly in regard to reducing the risk of thrombosis after knee arthroscopic surgery and anterior cruciate ligament reconstruction (ACLR). A meta-analysis on this topic was published recently in AJSM, titled ''Low-Molecular-Weight Heparin for the Prevention of Venous Thromboembolism in Patients Undergoing Knee Arthroscopic Surgery and Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Randomized Controlled Trials.'' 7 The meta-analysis concluded that ''compared with non-LMWH treatment, LMWH had no significant efficacy in preventing VTE [venous thromboembolism] in patients undergoing simple knee arthroscopic surgery but increased the risk of BEs [major bleeding events].'' 7 However, analysis of the article leads us to believe that it is not possible to reach such a conclusion, which we explain next.