A meta-analysis of thromboembolic prophylaxis in total knee arthroplasty

Deep venous thrombosis (DVT) is common in total knee arthroplasty (TKA). Be cause of the rarity of the most serious outcomes, most randomized controlle d trials lack the power to analyze these outcomes. A meta-analysis was perf ormed for agents used in DVT prophylaxis in TKA employing a Medline literat ure search. Study inclusion criteria were randomized controlled trials comp aring pro phylactic agents in elective TKA with mandatory screening for DVT by venography. Fourteen studies (3,482 patients) met inclusion criteria. F or total DVT, all agents except dextran and aspirin protected significantly better than placebo (P < .0001). For proximal DVT rates, low-molecular-wei ght heparin was significantly better than warfarin (P = .0002). There was a trend that aspirin was better than warfarin (P = .0106). No significant di fference was found for symptomatic pulmonary embolism, fatal pulmonary embo lism, major hemorrhage, or total mortality.