JOA - 2026-07-01 - Journal Article; Network Meta-Analysis; Research Support, Non-U.S. Gov't
Short versus Long Venous Thromboembolism Prophylaxis Following Elective Total Hip Arthroplasty: A Bayesian Network Meta-Analysis of Efficacy and Safety.
Kin Nam RH, Selim A, Gaddoura Z, Choudhary Z, Farhan-Alanie MM, Mohammad HR, Griffin XL, Thomas G
Topics
Key Takeaway
Extended-duration VTE prophylaxis after THA reduces symptomatic DVT by 47% (OR 1.87) and PE by 44% (OR 1.80) versus short-duration, with DOAC-long showing the lowest DVT risk across all five regimens.
Summary Depth
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Summary
This Bayesian NMA compared short- (10–14 days) versus extended-duration (28–35 days) LMWH, DOAC, and aspirin prophylaxis after THA across 25 studies (n=28,772). Extended-duration regimens reduced symptomatic DVT (OR 1.87, p=0.006) and PE (OR 1.80, p=0.043) without increasing major bleeding or 90-day mortality. In the five-arm NMA, DOAC-long had the lowest DVT risk while aspirin-long significantly increased DVT risk (OR 1.81) compared to the reference.
Key Limitation
Sensitivity analysis excluding pre-2000 studies eliminated the PE benefit of extended prophylaxis, suggesting baseline VTE rates in older trials inflate the apparent advantage of extended duration and may not reflect outcomes in contemporary enhanced recovery pathways with early mobilization.
Original Abstract
BACKGROUND
Pharmacological venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA) lacks consensus regarding optimal duration. We conducted a network meta-analysis (NMA) to evaluate the efficacy and safety of commonly used prophylactic strategies.
METHODS
This meta-analysis included studies up to April 2025 comparing short duration (10 to 14 days) and extended-duration (28 to 35 days) regimens of low molecular weight heparin, direct oral anticoagulants (DOACs), and aspirin after THA. Outcomes included symptomatic deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and 90-day mortality. The search yielded 1,733 records, of which 25 studies (n = 28,772; mean age 62 years; 54.3% women) were included.
RESULTS
Short-duration prophylaxis was associated with higher odds of symptomatic DVT (odds ratio (OR): 1.87 [1.19 to 2.94]; P = 0.006) and PE (1.80 [1.02 to 3.18]; P = 0.043) compared with extended-duration regimens, with no difference in bleeding or 90-day mortality. A sensitivity analysis excluding pre-2000 studies showed that the reduction in symptomatic DVT with extended-duration prophylaxis was less pronounced (OR: 1.79 [1.12 to 2.86]; P = 0.014), and the difference in PE was no longer significant. In the five-arm NMA, DOAC-long had the lowest DVT risk (OR 0.69 [0.42 to 1.14]), while low molecular weight heparin-short (OR: 1.97 [1.18 to 3.32]) and aspirin-long (OR: 1.81 [1.10 to 2.99]) significantly increased it. The DOAC-short had the lowest bleeding risk (OR: 0.71 [0.13 to 6.47]), but with high uncertainty. The PE and mortality differences were not significant.
CONCLUSIONS
Extended-duration prophylaxis was associated with reduced rates of symptomatic DVT and PE following THA. In the NMA, DOAC-long demonstrated the most favorable efficacy for reducing symptomatic DVT, with comparable results to DOAC-short, while DOAC-short had the lowest bleeding risk. Given evolving pathways that promote early mobilization, a contemporary trial is warranted to assess the net benefit of short-versus extended-duration prophylaxis.
LEVEL OF EVIDENCE
Level II.