Summary of findings 6. DOAC compared to heparin for people requiring prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair.
| DOAC compared to heparin for people requiring prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair | ||||||
| Patient or population: people requiring prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair Setting: hospital and outpatient setting Intervention: DOAC Comparison: heparin | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with heparin | Risk with DOAC | |||||
| Symptomatic VTE (DVT and PE) Treatment duration 28 ‐ 42 days | Study population | OR 0.70 (0.28 to 1.70) | 15977 (5 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | — | |
| 4 per 1000 | 3 per 1000 (1 to 8) | |||||
| Symptomatic DVT (proximal or distal) Treatment duration 28 ‐ 42 days |
Study population | OR 0.60 (0.11 to 3.27) | 15977 (5 RCTs) | ⊕⊕⊝⊝ LOW 2 3 | — | |
| 3 per 1000 | 2 per 1000 (0 to 9) | |||||
| Symptomatic PE Treatment duration 28 ‐ 42 days | Study population | OR 0.91 (0.43 to 1.94) | 14731 (5 RCTs) | ⊕⊕⊕⊝ MODERATE 2 | — | |
| 2 per 1000 | 2 per 1000 (1 to 4) | |||||
| Bleeding ‐ major Treatment duration 28 ‐ 42 days |
Study population | OR 1.11 (0.79 to 1.54) | 16199 (5 RCTs) | ⊕⊕⊕⊕ HIGH | — | |
| 8 per 1000 | 9 per 1000 (7 to 13) | |||||
| Bleeding ‐ clinically relevant, non‐major Treatment duration 28 ‐ 42 days | Study population | OR 1.08 (0.90 to 1.28) | 15241 (4 RCTs) | ⊕⊕⊕⊕ HIGH | — | |
| 33 per 1000 | 36 per 1000 (30 to 42) | |||||
| Bleeding ‐ minor Treatment duration 28 ‐ 42 days |
Study population | OR 0.95 (0.82 to 1.10) | 11766 (4 RCTs) | ⊕⊕⊕⊕ HIGH | — | |
| 66 per 1000 | 63 per 1000 (55 to 72) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; DOAC: direct oral anticoagulant; DVT: deep vein thrombosis; OR: odds ratio; PE: pulmonary embolism; RCT: randomised controlled trial; VTE: venous thromboembolism | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Downgraded by one level for inconsistency (heterogeneity, I2 = 55%) 2 Downgraded by one level for imprecision due to low number of events leading to wide CI 3 Downgraded by one level for inconsistency (heterogeneity, I2 = 65%)