Thromboprophylaxis after knee arthroscopy does not decrease the risk of deep vein thrombosis: a network meta-analysis

Abstract

PurposeThe primary aim of this network meta‐analysis (NMA) is to compare the incidence of venous thromboembolisms (VTE) and bleeding risk following the use of pharmacological and non‐pharmacological thromboprophylaxis for arthroscopic knee surgery (AKS). This study assumed the null hypothesis which was that there will be no difference in the incidence of VTE and bleeding risk when comparing no treatment, pharmacological treatment, and non‐pharmacological treatment for preventing VTE events following AKS. MethodsA systematic electronic search of CENTRAL, Medline, Embase, and ClinicalTrials.gov was carried out. All English language prospective randomized clinical trials published from date of database inception to November 21, 2021 were eligible for inclusion. All papers addressing arthroscopic knee surgery were eligible for inclusion regardless of timing of surgery, operation, surgical technique, or rehabilitation. Multiple random effects NMAs were conducted to compare all treatments for each outcome. The primary outcome was the incidence of pulmonary embolism (PE) and secondary outcomes consisted of overall deep vein thrombosis (DVT), symptomatic DVT, asymptomatic DVT, and all‐cause mortality. Adverse outcomes consisted of major and minor bleeding, as well as adverse events. ResultsA total of nine studies with 4526 patients were included for analysis. There were 1054 patients in the no treatment/placebo group (NT/Placebo), 1646 patients in the graduated compression stockings, 810 patients in the extended‐duration (> 10 days) low molecular weight heparin (Ext‐LMWH) group, 650 patients in the short‐duration (< 10 days) LMWH group (Short‐LMWH), and 356 patients in the rivaroxaban group. GCS, Ext‐LMWH, Short‐LMWH and rivaroxaban all demonstrated low risks of PE, symptomatic DVT, asymptomatic DVT, combined DVT and all‐cause mortality. Similarly, all interventions demonstrated a low risk of major bleeding. ConclusionThere is no significant difference in the risk reduction of PEs, symptomatic DVTs, major/minor bleeding, and/or all‐cause mortality when using LWMH (including short or extended regimens), rivaroxaban, graduated compression stockings or no treatment following arthroscopic knee surgery. Future primary research on the efficacy of thromboprophylaxis following arthroscopic knee surgery should stratify outcomes based on key patient (i.e., age, sex, comorbidities) and surgical (i.e., major vs. minor surgery) characteristics and should include acetylsalicylic acid as an intervention. Level of evidenceI, network meta‐analysis of Level I studies.

[Retracted] Effects of Modified Duhuo Jisheng Decoction Combined with Arthroscopic Surgery on Bone Metabolism, Oxidative Stress, and Serum TLR4 and TGF‐β1 in Patients with Knee Osteoarthritis

“…It has obvious effects on improving joint wear and meniscus damage, removing abnormal knee joint debris and proliferative tissue, and improving joint mobility. After knee arthroscopy, most patients can effectively control the development of the disease and avoid the need for knee replacement [ 13 , 14 ]. In this study, the WOMAC scores of 41 control patients were significantly reduced after arthroscopic surgery, and the bone metabolism indexes and oxidative stress indexes were well improved, indicating that arthroscopic surgery does have a certain therapeutic effect on KOA patients.…”

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.

“…As DVT protection, IPC was reported as inferior to or equal with placebo treatment after arthroscopic knee surgery. 12,13 Also, IPCþLMWH, compared with LMWH, did not reduce symptomatic DVT after prostatectomy. 14 Further, a small RCT among patients undergoing oesophagectomy found significant lower rates of VTE with LMWH compared with IPC (0 versus 22.6%, P ¼ 0.002) as the primary endpoint.…”

A guide to appropriately planning and conducting meta-analyses: part 3. Special considerations—the network meta-analysis

“…The authors reported that at the timepoint of 6 months post‐treatment, platelet‐rich plasma conferred the highest probability of pain reduction followed by plasma rich in growth factors, hyaluronic acid, corticosteroids, and placebo. Lameire et al[6] examined nine randomized controlled trials including 4526 patients to compare the efficacy of various methods in preventing deep vein thrombosis prophylaxis after knee arthroscopy. The authors compared placebo, graduated compression stockings, extended duration (> 10 days) low molecular weight heparin, short duration (< 10 days) low molecular weight heparin, and rivaroxaban.…”