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. 2016 Mar 30;2016(3):CD004179. doi: 10.1002/14651858.CD004179.pub2
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
Total VTE (symptomatic and asymptomatic)
Treatment duration 28 ‐ 42 days		 Study population OR 0.53
 (0.29 to 0.97) 12447
 (4 RCTs) ⊕⊕⊕⊝
 MODERATE 1 —
41 per 1000 22 per 1000
 (12 to 40)
Asymptomatic DVT
Treatment duration 28 ‐ 42 days		 Study population OR 0.56
 (0.19 to 1.59) 6559
 (2 RCTs) ⊕⊕⊝⊝
 LOW 2 —
42 per 1000 24 per 1000
 (8 to 65)
Asymptomatic proximal DVT
Treatment duration 28 ‐ 42 days		 Study population OR 0.73
 (0.46 to 1.15) 2704
 (1 RCT) ⊕⊕⊕⊝
 MODERATE 3 —
35 per 1000 26 per 1000
 (16 to 40)
Asymptomatic distal DVT
Treatment duration 28 ‐ 42 days		 Study population OR 1.22
 (0.75 to 1.99) 2639
 (1 RCT) ⊕⊕⊕⊝
 MODERATE 3 —
27 per 1000 33 per 1000
 (20 to 52)
All‐cause mortality
Treatment duration 28 ‐ 42 days		 Study population OR 1.63
 (0.64 to 4.16) 14966
 (5 RCTs) ⊕⊕⊕⊝
 MODERATE 4 —
1 per 1000 1 per 1000
 (1 to 4)
Adverse events
Treatment duration 28 ‐ 42 days		 Study population OR 0.96
 (0.88 to 1.05) 9908
 (3 RCTs) ⊕⊕⊕⊕
 HIGH —
691 per 1000 682 per 1000
 (663 to 701)
Reoperation
Treatment duration 28 ‐ 42 days		 Study population OR 1.06
 (0.34 to 3.24) 15241
 (4 RCTs) ⊕⊕⊕⊝
 MODERATE 4 —
1 per 1000 1 per 1000
 (0 to 2)
Wound infection
Treatment duration 28 ‐ 42 days		 Study population OR 0.89
 (0.46 to 1.72) 6446
 (2 RCTs) ⊕⊕⊕⊝
 MODERATE 4 —
6 per 1000 5 per 1000
 (3 to 10)
Wound healing
Treatment duration 28 ‐ 42 days		 see comment — — — not reported in five included studies in this comparison
*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