Original ArticlesA meta-analysis of thromboembolic prophylaxis in total knee arthroplasty*,**
Section snippets
Materials and methods
A literature search was performed on Medline for studies from January 1966 to December 1999 to identify all English-language literature included under the key words knee, knee arthroplasty, knee replacement, thrombosis, thromboembolism, pulmonary embolism, and prophylaxis. The following strict methodologic criteria were used to select studies for inclusion: i) prospective, randomized controlled trials involving one of the prophylactic agents of interest compared with another method of interest
Results
Seventeen studies met inclusion criteria. Three studies were excluded, however, because their data were repeated elsewhere. One study [19] included some new data that superseded some old data; all overlapping data were counted only once. Consequently, 14 studies with 3,482 patients were analyzed and included in this meta-analysis. Demographics are listed in Table 1.Agent No. Studies No. Patients Mean Age (y) Mean % Male Mean Day of Venogram References LMWH 11 1793 67.6 65 7.9 2, 5, 6, 14, 15, 18
Discussion
Although the incidence of total DVT is high in the literature (84% in earlier studies), PE more commonly arises from proximal DVT, which is much less common (0-16%), than from distal DVT. There is consensus that distal DVT often is clinically unimportant and does not require treatment. Because of questions regarding efficacy and safety of commonly used prophylactic agents as well as which outcomes are important to prevent, there is no consensus as to which agent, if any, should be used for
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No benefits or funds were received in support of this study.
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Reprint requests: K. R. Brookenthal, MD, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104. E-mail: [email protected]