PB1475 - Network Meta-analysis Identifies a Care Gap in Optimizing Thromboprophylaxis Following Hip Fracture Surgery

Background: Venous thromboembolism (VTE) is the second most common complication following hip fracture surgery (HFS) and is a significant cause of mortality. There is a lack of consensus on the optimal thromboprophylaxis regimen following HFS; therefore, the impact of variation in thromboprophylaxis prescription on VTE and bleeding outcomes remains undefined.

Aims: To evaluate current evidence in order to determine comparative treatment effect of different pharmacologic thromboprophylaxis types on the incidence of VTE and bleeding complications after hip fracture surgery.

Methods: A systematic review and network meta-analysis (NMA) design was used to compare the effectiveness of multiple thromboprophylaxis interventions. A systematic search between January 2000 and February 2022 using EMBASE, MEDLINE, and the Cochrane Central Registry of Controlled Trials (CENTRAL) databases was performed. Included studies evaluated the treatment effect of thromboprophylaxis agents (i.e., direct oral anticoagulants (DOAC), low-molecular weight heparin (LMWH), unfractionated heparin (UFH), acetylsalicylic acid (ASA), and warfarin) prescribed following HFS. The primary and secondary outcome measures were treatment effect on VTE and bleeding, respectively. Comparators were ‘placebo’ or ‘other intervention.’ Data were synthesized using Bayesian NMA, and dichotomous data were pooled using odds ratio effect size.

Results: Of the 466 citations screened, 77 articles underwent full-text review, and 19 studies (9 RCTs and 10 observational studies) met inclusion criteria for evaluation of the primary VTE outcome (n=49,409). Three studies examined bleeding complications (n=18,163). Larger bodies of evidence were identified with LMWH and DOAC trials, with most studies comparing LMWH versus other interventions (Figure 1). Of the interventions evaluated, no significant differences in VTE or bleeding outcomes were identified compared to placebo (Figure 2).

Conclusion(s): The network meta-analysis demonstrated variations in thromboprophylaxis interventions following hip fracture surgery, with no optimal thromboprophylaxis strategy identified. Further prospective investigation to determine the safest and most effective thromboprophylaxis agent for patients with hip fractures is warranted.