Authors' objectives:

This evaluation summarizes an analysis commissioned by CCOHTA. The three primary purposes of the original study were:

to compare the safety and efficacy of three low molecular weight heparins (LMWH) (deltaparin, enoxaparin and tinzaparin)

to compare the ability of LMWH with unfractionated heparin (UFH) and warfarin in reducing symptomatic DVT and pulmonary embolism (PE)

to conduct a cost-effectiveness analysis using symptomatic outcomes and compare these results to existing economic analyses that used venography detectedoutcomes.

Authors' recommendations: It appears that the incidence of symptomatic DVT is one fifth to one tenth of the incidence of venography detected DVT. Although venography diagnosed DVT rates have been found consistently higher in total knee arthroplasty versus total hip arthroplasty, rates of symptomatic venous thromboembolic complications were similar between surgeries. No apparent differences in efficacy among the various LMWH were found in the prevention of venographically diagnosed thromboembolism in patients undergoing hip or knee arthroplasty. LMWH were significantly more efficacious than UFH at preventing venography detected DVT in patients undergoing total hip or knee arthroplasty. LMWH were significantly more efficacious than warfarin at preventing venography detected total DVT in patients undergoing knee arthroplasty. No such difference was observed in patients undergoing hip arthroplasty. Warfarin prophylaxis was as equally efficacious as LMWH in preventing symptomatic thromboembolic complications following total hip arthroplasty. Although warfarin was found to be more efficacious than LMWH in total knee arthroplasty, the cost-effectiveness analysis assumed similar efficacy due to limited data. Meta-analysis of four major trials showed the risk of major bleeds was more than double with LMWH prophylaxis than warfarin.

Authors' methods: Review

Project Status: Completed

URL for project: https://www.ccohta.ca/

Year Published: 1998

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Coordinating Office for Health Technology Assessment

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553, Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Coordinating Office for Health Technology Assessment