Scolaris Content Display Scolaris Content Display

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Heparin versus placebo, Outcome 1 Symptomatic VTE (DVT and PE).
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Analysis 1.1

Comparison 1 Heparin versus placebo, Outcome 1 Symptomatic VTE (DVT and PE).

Comparison 1 Heparin versus placebo, Outcome 2 Symptomatic DVT (proximal or distal).
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Analysis 1.2

Comparison 1 Heparin versus placebo, Outcome 2 Symptomatic DVT (proximal or distal).

Comparison 1 Heparin versus placebo, Outcome 3 Symptomatic PE.
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Analysis 1.3

Comparison 1 Heparin versus placebo, Outcome 3 Symptomatic PE.

Comparison 1 Heparin versus placebo, Outcome 4 Total VTE (symptomatic and asymptomatic).
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Analysis 1.4

Comparison 1 Heparin versus placebo, Outcome 4 Total VTE (symptomatic and asymptomatic).

Comparison 1 Heparin versus placebo, Outcome 5 Asymptomatic DVT.
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Analysis 1.5

Comparison 1 Heparin versus placebo, Outcome 5 Asymptomatic DVT.

Comparison 1 Heparin versus placebo, Outcome 6 All‐cause mortality.
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Analysis 1.6

Comparison 1 Heparin versus placebo, Outcome 6 All‐cause mortality.

Comparison 1 Heparin versus placebo, Outcome 7 Adverse events.
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Analysis 1.7

Comparison 1 Heparin versus placebo, Outcome 7 Adverse events.

Comparison 1 Heparin versus placebo, Outcome 8 Bleeding ‐ major.
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Analysis 1.8

Comparison 1 Heparin versus placebo, Outcome 8 Bleeding ‐ major.

Comparison 1 Heparin versus placebo, Outcome 9 Bleeding ‐ minor.
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Analysis 1.9

Comparison 1 Heparin versus placebo, Outcome 9 Bleeding ‐ minor.

Comparison 1 Heparin versus placebo, Outcome 10 Reoperation.
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Analysis 1.10

Comparison 1 Heparin versus placebo, Outcome 10 Reoperation.

Comparison 2 Vitamin K antagonists versus placebo, Outcome 1 Symptomatic VTE (DVT and PE).
Figures and Tables -
Analysis 2.1

Comparison 2 Vitamin K antagonists versus placebo, Outcome 1 Symptomatic VTE (DVT and PE).

Comparison 2 Vitamin K antagonists versus placebo, Outcome 2 Symptomatic DVT (proximal or distal).
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Analysis 2.2

Comparison 2 Vitamin K antagonists versus placebo, Outcome 2 Symptomatic DVT (proximal or distal).

Comparison 2 Vitamin K antagonists versus placebo, Outcome 3 Symptomatic PE.
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Analysis 2.3

Comparison 2 Vitamin K antagonists versus placebo, Outcome 3 Symptomatic PE.

Comparison 2 Vitamin K antagonists versus placebo, Outcome 4 Total VTE (symptomatic and asymptomatic).
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Analysis 2.4

Comparison 2 Vitamin K antagonists versus placebo, Outcome 4 Total VTE (symptomatic and asymptomatic).

Comparison 2 Vitamin K antagonists versus placebo, Outcome 5 All‐cause mortality.
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Analysis 2.5

Comparison 2 Vitamin K antagonists versus placebo, Outcome 5 All‐cause mortality.

Comparison 2 Vitamin K antagonists versus placebo, Outcome 6 Adverse events.
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Analysis 2.6

Comparison 2 Vitamin K antagonists versus placebo, Outcome 6 Adverse events.

Comparison 2 Vitamin K antagonists versus placebo, Outcome 7 Bleeding ‐ major.
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Analysis 2.7

Comparison 2 Vitamin K antagonists versus placebo, Outcome 7 Bleeding ‐ major.

Comparison 3 DOAC versus placebo, Outcome 1 Symptomatic VTE (DVT and PE).
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Analysis 3.1

Comparison 3 DOAC versus placebo, Outcome 1 Symptomatic VTE (DVT and PE).

Comparison 3 DOAC versus placebo, Outcome 2 Symptomatic DVT (proximal or distal).
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Analysis 3.2

Comparison 3 DOAC versus placebo, Outcome 2 Symptomatic DVT (proximal or distal).

Comparison 3 DOAC versus placebo, Outcome 3 Symptomatic PE.
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Analysis 3.3

Comparison 3 DOAC versus placebo, Outcome 3 Symptomatic PE.

Comparison 3 DOAC versus placebo, Outcome 4 Total VTE (symptomatic and asymptomatic).
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Analysis 3.4

Comparison 3 DOAC versus placebo, Outcome 4 Total VTE (symptomatic and asymptomatic).

Comparison 3 DOAC versus placebo, Outcome 5 All‐cause mortality.
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Analysis 3.5

Comparison 3 DOAC versus placebo, Outcome 5 All‐cause mortality.

Comparison 3 DOAC versus placebo, Outcome 6 Adverse events.
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Analysis 3.6

Comparison 3 DOAC versus placebo, Outcome 6 Adverse events.

Comparison 3 DOAC versus placebo, Outcome 7 Bleeding ‐ major.
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Analysis 3.7

Comparison 3 DOAC versus placebo, Outcome 7 Bleeding ‐ major.

Comparison 3 DOAC versus placebo, Outcome 8 Bleeding‐ clinically relevant non‐major.
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Analysis 3.8

Comparison 3 DOAC versus placebo, Outcome 8 Bleeding‐ clinically relevant non‐major.

Comparison 3 DOAC versus placebo, Outcome 9 Bleeding ‐ minor.
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Analysis 3.9

Comparison 3 DOAC versus placebo, Outcome 9 Bleeding ‐ minor.

Comparison 3 DOAC versus placebo, Outcome 10 Reoperation.
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Analysis 3.10

Comparison 3 DOAC versus placebo, Outcome 10 Reoperation.

Comparison 3 DOAC versus placebo, Outcome 11 Wound infection.
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Analysis 3.11

Comparison 3 DOAC versus placebo, Outcome 11 Wound infection.

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 1 Symptomatic VTE (DVT and PE).
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Analysis 4.1

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 1 Symptomatic VTE (DVT and PE).

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 2 Symptomatic DVT (proximal or distal).
Figures and Tables -
Analysis 4.2

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 2 Symptomatic DVT (proximal or distal).

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 3 Symptomatic PE.
Figures and Tables -
Analysis 4.3

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 3 Symptomatic PE.

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 4 Total VTE (symptomatic and asymptomatic).
Figures and Tables -
Analysis 4.4

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 4 Total VTE (symptomatic and asymptomatic).

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 5 Asymptomatic DVT.
Figures and Tables -
Analysis 4.5

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 5 Asymptomatic DVT.

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 6 Asymptomatic distal DVT.
Figures and Tables -
Analysis 4.6

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 6 Asymptomatic distal DVT.

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 7 All‐cause mortality.
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Analysis 4.7

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 7 All‐cause mortality.

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 8 Bleeding ‐ major.
Figures and Tables -
Analysis 4.8

Comparison 4 Anticoagulant (chosen at investigators' discretion) versus placebo, Outcome 8 Bleeding ‐ major.

Comparison 5 Vitamin K antagonists versus heparin, Outcome 1 Symptomatic VTE (DVT and PE).
Figures and Tables -
Analysis 5.1

Comparison 5 Vitamin K antagonists versus heparin, Outcome 1 Symptomatic VTE (DVT and PE).

Comparison 5 Vitamin K antagonists versus heparin, Outcome 2 Symptomatic DVT (proximal or distal).
Figures and Tables -
Analysis 5.2

Comparison 5 Vitamin K antagonists versus heparin, Outcome 2 Symptomatic DVT (proximal or distal).

Comparison 5 Vitamin K antagonists versus heparin, Outcome 3 Symptomatic PE.
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Analysis 5.3

Comparison 5 Vitamin K antagonists versus heparin, Outcome 3 Symptomatic PE.

Comparison 5 Vitamin K antagonists versus heparin, Outcome 4 Total VTE (symptomatic and asymptomatic).
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Analysis 5.4

Comparison 5 Vitamin K antagonists versus heparin, Outcome 4 Total VTE (symptomatic and asymptomatic).

Comparison 5 Vitamin K antagonists versus heparin, Outcome 5 All‐cause mortality.
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Analysis 5.5

Comparison 5 Vitamin K antagonists versus heparin, Outcome 5 All‐cause mortality.

Comparison 5 Vitamin K antagonists versus heparin, Outcome 6 Bleeding ‐ major.
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Analysis 5.6

Comparison 5 Vitamin K antagonists versus heparin, Outcome 6 Bleeding ‐ major.

Comparison 5 Vitamin K antagonists versus heparin, Outcome 7 Bleeding ‐ minor.
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Analysis 5.7

Comparison 5 Vitamin K antagonists versus heparin, Outcome 7 Bleeding ‐ minor.

Comparison 5 Vitamin K antagonists versus heparin, Outcome 8 Reoperation.
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Analysis 5.8

Comparison 5 Vitamin K antagonists versus heparin, Outcome 8 Reoperation.

Comparison 6 DOAC versus heparin, Outcome 1 Symptomatic VTE (DVT and PE).
Figures and Tables -
Analysis 6.1

Comparison 6 DOAC versus heparin, Outcome 1 Symptomatic VTE (DVT and PE).

Comparison 6 DOAC versus heparin, Outcome 2 Symptomatic DVT (proximal or distal).
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Analysis 6.2

Comparison 6 DOAC versus heparin, Outcome 2 Symptomatic DVT (proximal or distal).

Comparison 6 DOAC versus heparin, Outcome 3 Symptomatic PE.
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Analysis 6.3

Comparison 6 DOAC versus heparin, Outcome 3 Symptomatic PE.

Comparison 6 DOAC versus heparin, Outcome 4 Total VTE (symptomatic and asymptomatic).
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Analysis 6.4

Comparison 6 DOAC versus heparin, Outcome 4 Total VTE (symptomatic and asymptomatic).

Comparison 6 DOAC versus heparin, Outcome 5 Asymptomatic DVT.
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Analysis 6.5

Comparison 6 DOAC versus heparin, Outcome 5 Asymptomatic DVT.

Comparison 6 DOAC versus heparin, Outcome 6 Asymptomatic proximal DVT.
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Analysis 6.6

Comparison 6 DOAC versus heparin, Outcome 6 Asymptomatic proximal DVT.

Comparison 6 DOAC versus heparin, Outcome 7 Asymptomatic distal DVT.
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Analysis 6.7

Comparison 6 DOAC versus heparin, Outcome 7 Asymptomatic distal DVT.

Comparison 6 DOAC versus heparin, Outcome 8 All‐cause mortality.
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Analysis 6.8

Comparison 6 DOAC versus heparin, Outcome 8 All‐cause mortality.

Comparison 6 DOAC versus heparin, Outcome 9 Adverse events.
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Analysis 6.9

Comparison 6 DOAC versus heparin, Outcome 9 Adverse events.

Comparison 6 DOAC versus heparin, Outcome 10 Bleeding ‐ major.
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Analysis 6.10

Comparison 6 DOAC versus heparin, Outcome 10 Bleeding ‐ major.

Comparison 6 DOAC versus heparin, Outcome 11 Bleeding ‐ clinically relevant, non‐major.
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Analysis 6.11

Comparison 6 DOAC versus heparin, Outcome 11 Bleeding ‐ clinically relevant, non‐major.

Comparison 6 DOAC versus heparin, Outcome 12 Bleeding ‐ minor.
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Analysis 6.12

Comparison 6 DOAC versus heparin, Outcome 12 Bleeding ‐ minor.

Comparison 6 DOAC versus heparin, Outcome 13 Reoperation.
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Analysis 6.13

Comparison 6 DOAC versus heparin, Outcome 13 Reoperation.

Comparison 6 DOAC versus heparin, Outcome 14 Wound infection.
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Analysis 6.14

Comparison 6 DOAC versus heparin, Outcome 14 Wound infection.

Summary of findings for the main comparison. Heparin compared to placebo for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair

Heparin compared to placebo for 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: heparin
Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with placebo

Risk with heparin

Symptomatic VTE (DVT and PE)
Treatment duration 28 ‐ 42 days

Study population

OR 0.59
(0.35 to 1.01)

2329
(5 RCTs)

⊕⊕⊕⊕
HIGH

33 per 1000

20 per 1000
(12 to 33)

Symptomatic DVT (proximal or distal)
Treatment duration 28 ‐ 42 days

Study population

OR 0.73
(0.39 to 1.38)

2019
(4 RCTs)

⊕⊕⊕⊝
MODERATE 1

24 per 1000

18 per 1000
(9 to 33)

Symptomatic PE
Treatment duration 28 ‐ 42 days

Study population

OR 0.61
(0.16 to 2.33)

1595
(3 RCTs)

⊕⊕⊝⊝
LOW 1 2

6 per 1000

4 per 1000
(1 to 15)

Bleeding ‐ major
Treatment duration 28 ‐ 42 days

Study population

OR 0.59
(0.14 to 2.46)

2500
(5 RCTs)

⊕⊕⊕⊝
MODERATE 1

4 per 1000

2 per 1000
(0 to 9)

Clinically relevant non‐major bleeding
Treatment duration 28 ‐ 42 days

see comment

not reported

Bleeding ‐ minor
Treatment duration 28 ‐ 42 days

Study population

OR 2.01
(1.43 to 2.81)

2500
(5 RCTs)

⊕⊕⊕⊕
HIGH

46 per 1000

88 per 1000
(65 to 119)

*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; 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, low number of events leading to imprecision of results
2 Downgraded by one level, some heterogeneity present (I2 = 49%) leading to wide CIs

Figures and Tables -
Summary of findings for the main comparison. Heparin compared to placebo for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
Summary of findings 2. Vitamin K antagonists compared to placebo for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair

Vitamin K antagonists compared to placebo for 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: vitamin K antagonists
Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with placebo

Risk with vitamin K antagonists

Symptomatic VTE (DVT and PE)
Treatment duration 28 ‐ 42 days

Study population

OR 0.10
(0.01 to 1.94)

360
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

23 per 1000

2 per 1000
(0 to 43)

Symptomatic DVT (proximal or distal)
Treatment duration 28 ‐ 42 days

Study population

OR 0.13
(0.01 to 2.62)

360
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

17 per 1000

2 per 1000
(0 to 43)

Symptomatic PE
Treatment duration 28 ‐ 42 days

Study population

OR 0.32
(0.01 to 7.84)

360
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

6 per 1000

2 per 1000
(0 to 43)

Bleeding ‐ major
Treatment duration 28 ‐ 42 days

see comment

OR 2.89
(0.12 to 71.31)

360
(1 RCT)

⊕⊕⊝⊝
LOW 1 2

no events recorded in placebo group

Clinically relevant non‐major bleeding
Treatment duration 28 ‐ 42 days

see comment

not reported

Minor bleeding
Treatment duration 28 ‐ 42 days

see comment

not reported

*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; 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, results from a single study only so heterogeneity could not be assessed
2 Downgraded by one level, number of events small leading to wide CI and imprecision of results

Figures and Tables -
Summary of findings 2. Vitamin K antagonists compared to placebo for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
Summary of findings 3. DOAC compared to placebo for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair

DOAC compared to placebo for 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: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with placebo

Risk with DOAC

Symptomatic VTE (DVT and PE)
Treatment duration 28 ‐ 42 days

Study population

OR 0.20
(0.06 to 0.68)

2419
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

12 per 1000

3 per 1000
(1 to 8)

Symptomatic DVT (proximal or distal)
Treatment duration 28 ‐ 42 days

Study population

OR 0.18
(0.04 to 0.81)

2459
(2 RCTs)

⊕⊕⊕⊕
HIGH

9 per 1000

2 per 1000
(0 to 7)

Symptomatic PE
Treatment duration 28 ‐ 42 days

Study population

OR 0.25
(0.03 to 2.25)

1733
(1 RCT)

⊕⊕⊝⊝
LOW 1 2

5 per 1000

1 per 1000
(0 to 10)

Bleeding ‐ major
Treatment duration 28 ‐ 42 days

Study population

OR 1.00
(0.06 to 16.02)

2457
(1 RCT)

⊕⊕⊝⊝
LOW 1 2

1 per 1000

1 per 1000
(0 to 13)

Bleeding‐ clinically relevant non‐major
Treatment duration 28 ‐ 42 days

Study population

OR 1.22
(0.76 to 1.95)

2457
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

27 per 1000

33 per 1000
(21 to 51)

Bleeding ‐ minor
Treatment duration 28 ‐ 42 days

Study population

OR 1.18
(0.74 to 1.88)

2457
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

28 per 1000

32 per 1000
(21 to 51)

*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, results from a single study so heterogeneity cannot be assessed
2 Downgraded by one level, low number of events leading to wide CI and imprecision of results

Figures and Tables -
Summary of findings 3. DOAC compared to placebo for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
Summary of findings 4. Anticoagulants (chosen at investigators' discretion) compared to placebo for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair

Anticoagulants (chosen at investigators' discretion) compared to placebo for 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: anticoagulant (chosen at investigators' discretion)
Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with placebo

Risk with anticoagulant (chosen at investigators' discretion)

Symptomatic VTE (DVT and PE)
Treatment duration 28 ‐ 42 days

Study population

OR 0.50
(0.09 to 2.74)

557
(1 RCT)

⊕⊕⊝⊝
LOW 1 2

14 per 1000

7 per 1000
(1 to 38)

Symptomatic DVT (proximal or distal)
Treatment duration 28 ‐ 42 days

Study population

OR 0.33
(0.03 to 3.21)

557
(1 RCT)

⊕⊕⊝⊝
LOW 1 2

11 per 1000

4 per 1000
(0 to 34)

Symptomatic PE
Treatment duration 28 ‐ 42 days

Study population

OR 1.00
(0.06 to 16.13)

557
(1 RCT)

⊕⊕⊝⊝
LOW 1 2

4 per 1000

4 per 1000
(0 to 55)

Bleeding ‐ major
Treatment duration 28 ‐ 42 days

see comment

OR 5.05
(0.24 to 105.76)

557
(1 RCT)

⊕⊕⊝⊝
LOW 1 2

no major bleeding recorded in the placebo groups

Clinically relevant non‐major bleeding
Treatment duration 28 ‐ 42 days

see comment

not reported

Minor bleeding
Treatment duration 28 ‐ 42 days

see comment

not reported

*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; 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, results from a single study so heterogeneity could not be assessed
2 Downgraded by one level, low number of events leading to wide CIs and imprecision of results

Figures and Tables -
Summary of findings 4. Anticoagulants (chosen at investigators' discretion) compared to placebo for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
Summary of findings 5. Vitamin K antagonists compared to heparin for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair

Vitamin K antagonists compared to heparin for 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: vitamin K antagonists
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 vitamin K antagonists

Symptomatic VTE (DVT and PE)
Treatment duration 28 ‐ 42 days

Study population

OR 1.64
(0.85 to 3.16)

1279
(1 RCT)

⊕⊕⊝⊝
LOW 1 2

23 per 1000

38 per 1000
(20 to 70)

Symptomatic DVT (proximal or distal)
Treatment duration 28 ‐ 42 days

Study population

OR 1.36
(0.69 to 2.68)

1279
(1 RCT)

⊕⊕⊝⊝
LOW 1 2

23 per 1000

31 per 1000
(16 to 60)

Symptomatic PE
Treatment duration 28 ‐ 42 days

see comment

OR 9.16
(0.49 to 170.42)

1279
(1 RCT)

⊕⊕⊝⊝
LOW 1 3

no cases of symptomatic PE reported in the heparin study arm

Bleeding ‐ major
Treatment duration 28 ‐ 42 days

Study population

OR 3.87
(1.91 to 7.85)

1272
(1 RCT)

⊕⊕⊝⊝
LOW 1 2

16 per 1000

58 per 1000
(30 to 111)

Bleeding ‐ clinically indicated non‐major

Treatment duration 28 ‐ 42 days

see comment

clinically indicated non‐major bleeding events not reported in single included study in this comparison

Bleeding ‐ minor
Treatment duration 28 ‐ 42 days

Study population

OR 1.33
(0.64 to 2.76)

1279
(1 RCT)

⊕⊕⊝⊝
LOW 1 2

20 per 1000

27 per 1000
(13 to 54)

*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; DVT: deep vein thrombosis; OR: odds ratio; PE: pulmonary embolism; RCT: randomised controlled trial; VKA: vitamin K antagonist; 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, single study so heterogeneity could not be assessed
2 Downgraded by one level, wide CI
3 Downgraded by one level, low number of events leading to imprecision of results

Figures and Tables -
Summary of findings 5. Vitamin K antagonists compared to heparin for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair
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%)

Figures and Tables -
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
Comparison 1. Heparin versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Symptomatic VTE (DVT and PE) Show forest plot

5

2329

Odds Ratio (M‐H, Fixed, 95% CI)

0.59 [0.35, 1.01]

1.1 Hip replacement

4

1296

Odds Ratio (M‐H, Fixed, 95% CI)

0.69 [0.36, 1.30]

1.2 Knee replacement

1

723

Odds Ratio (M‐H, Fixed, 95% CI)

0.78 [0.21, 2.92]

1.3 Hip or knee replacement

1

310

Odds Ratio (M‐H, Fixed, 95% CI)

0.22 [0.05, 1.06]

2 Symptomatic DVT (proximal or distal) Show forest plot

4

2019

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.39, 1.38]

2.1 Hip replacement

4

1296

Odds Ratio (M‐H, Fixed, 95% CI)

0.80 [0.41, 1.55]

2.2 Knee replacement

1

723

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.03, 3.12]

3 Symptomatic PE Show forest plot

3

1595

Odds Ratio (M‐H, Fixed, 95% CI)

0.61 [0.16, 2.33]

3.1 Hip replacement

3

872

Odds Ratio (M‐H, Fixed, 95% CI)

0.13 [0.01, 2.56]

3.2 Knee replacement

1

723

Odds Ratio (M‐H, Fixed, 95% CI)

1.47 [0.24, 8.83]

4 Total VTE (symptomatic and asymptomatic) Show forest plot

6

2544

Odds Ratio (M‐H, Fixed, 95% CI)

0.39 [0.28, 0.56]

4.1 Hip replacement

5

1511

Odds Ratio (M‐H, Fixed, 95% CI)

0.37 [0.25, 0.56]

4.2 Knee replacement

1

723

Odds Ratio (M‐H, Fixed, 95% CI)

0.78 [0.21, 2.92]

4.3 Hip or knee replacement

1

310

Odds Ratio (M‐H, Fixed, 95% CI)

0.38 [0.16, 0.90]

5 Asymptomatic DVT Show forest plot

5

1304

Odds Ratio (M‐H, Fixed, 95% CI)

0.38 [0.24, 0.60]

5.1 Hip replacement

4

994

Odds Ratio (M‐H, Fixed, 95% CI)

0.35 [0.21, 0.58]

5.2 Hip or knee replacement

1

310

Odds Ratio (M‐H, Fixed, 95% CI)

0.54 [0.19, 1.52]

6 All‐cause mortality Show forest plot

5

2518

Odds Ratio (M‐H, Fixed, 95% CI)

1.01 [0.31, 3.26]

6.1 Hip replacement

4

1485

Odds Ratio (M‐H, Fixed, 95% CI)

0.56 [0.11, 2.75]

6.2 Knee replacement

1

723

Odds Ratio (M‐H, Fixed, 95% CI)

0.98 [0.06, 15.65]

6.3 Hip or knee replacement

1

310

Odds Ratio (M‐H, Fixed, 95% CI)

4.69 [0.22, 98.42]

7 Adverse events Show forest plot

2

460

Odds Ratio (M‐H, Fixed, 95% CI)

1.06 [0.68, 1.64]

7.1 Hip replacement

2

460

Odds Ratio (M‐H, Fixed, 95% CI)

1.06 [0.68, 1.64]

8 Bleeding ‐ major Show forest plot

5

2500

Odds Ratio (M‐H, Fixed, 95% CI)

0.59 [0.14, 2.46]

8.1 Hip replacement

4

1494

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.03, 3.10]

8.2 Knee replacement

1

696

Odds Ratio (M‐H, Fixed, 95% CI)

0.99 [0.14, 7.06]

8.3 Hip or knee replacement

1

310

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Bleeding ‐ minor Show forest plot

5

2500

Odds Ratio (M‐H, Fixed, 95% CI)

2.01 [1.43, 2.81]

9.1 Hip replacement

4

1494

Odds Ratio (M‐H, Fixed, 95% CI)

2.25 [1.53, 3.30]

9.2 Knee replacement

1

696

Odds Ratio (M‐H, Fixed, 95% CI)

1.23 [0.58, 2.59]

9.3 Hip or knee replacement

1

310

Odds Ratio (M‐H, Fixed, 95% CI)

2.79 [0.11, 69.13]

10 Reoperation Show forest plot

1

179

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.1 Hip replacement

1

179

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Heparin versus placebo
Comparison 2. Vitamin K antagonists versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Symptomatic VTE (DVT and PE) Show forest plot

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

0.10 [0.01, 1.94]

1.1 Hip replacement

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

0.10 [0.01, 1.94]

2 Symptomatic DVT (proximal or distal) Show forest plot

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

0.13 [0.01, 2.62]

2.1 Hip replacement

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

0.13 [0.01, 2.62]

3 Symptomatic PE Show forest plot

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 7.84]

3.1 Hip replacement

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 7.84]

4 Total VTE (symptomatic and asymptomatic) Show forest plot

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

0.10 [0.01, 0.81]

4.1 Hip replacement

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

0.10 [0.01, 0.81]

5 All‐cause mortality Show forest plot

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.1 Hip replacement

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Adverse events Show forest plot

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.1 Hip replacement

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Bleeding ‐ major Show forest plot

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

2.89 [0.12, 71.31]

7.1 Hip replacement

1

360

Odds Ratio (M‐H, Fixed, 95% CI)

2.89 [0.12, 71.31]

Figures and Tables -
Comparison 2. Vitamin K antagonists versus placebo
Comparison 3. DOAC versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Symptomatic VTE (DVT and PE) Show forest plot

1

2419

Odds Ratio (M‐H, Fixed, 95% CI)

0.20 [0.06, 0.68]

1.1 Hip replacement

1

2419

Odds Ratio (M‐H, Fixed, 95% CI)

0.20 [0.06, 0.68]

2 Symptomatic DVT (proximal or distal) Show forest plot

2

2459

Odds Ratio (M‐H, Fixed, 95% CI)

0.18 [0.04, 0.81]

2.1 Hip replacement

2

2459

Odds Ratio (M‐H, Fixed, 95% CI)

0.18 [0.04, 0.81]

3 Symptomatic PE Show forest plot

1

1733

Odds Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.25]

3.1 Hip replacement

1

1733

Odds Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.25]

4 Total VTE (symptomatic and asymptomatic) Show forest plot

1

1733

Odds Ratio (M‐H, Fixed, 95% CI)

0.19 [0.11, 0.33]

4.1 Hip replacement

1

1733

Odds Ratio (M‐H, Fixed, 95% CI)

0.19 [0.11, 0.33]

5 All‐cause mortality Show forest plot

1

1733

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.07, 1.66]

5.1 Hip replacement

1

1733

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.07, 1.66]

6 Adverse events Show forest plot

1

2457

Odds Ratio (M‐H, Fixed, 95% CI)

0.87 [0.74, 1.03]

6.1 Hip replacement

1

2457

Odds Ratio (M‐H, Fixed, 95% CI)

0.87 [0.74, 1.03]

7 Bleeding ‐ major Show forest plot

1

2457

Odds Ratio (M‐H, Fixed, 95% CI)

1.00 [0.06, 16.02]

7.1 Hip replacement

1

2457

Odds Ratio (M‐H, Fixed, 95% CI)

1.00 [0.06, 16.02]

8 Bleeding‐ clinically relevant non‐major Show forest plot

1

2457

Odds Ratio (M‐H, Fixed, 95% CI)

1.22 [0.76, 1.95]

8.1 Hip replacement

1

2457

Odds Ratio (M‐H, Fixed, 95% CI)

1.22 [0.76, 1.95]

9 Bleeding ‐ minor Show forest plot

1

2457

Odds Ratio (M‐H, Fixed, 95% CI)

1.18 [0.74, 1.88]

9.1 Hip replacement

1

2457

Odds Ratio (M‐H, Fixed, 95% CI)

1.18 [0.74, 1.88]

10 Reoperation Show forest plot

1

2457

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.1 Hip replacement

1

2457

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Wound infection Show forest plot

1

2457

Odds Ratio (M‐H, Fixed, 95% CI)

1.34 [0.46, 3.86]

11.1 Hip replacement

1

2457

Odds Ratio (M‐H, Fixed, 95% CI)

1.34 [0.46, 3.86]

Figures and Tables -
Comparison 3. DOAC versus placebo
Comparison 4. Anticoagulant (chosen at investigators' discretion) versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Symptomatic VTE (DVT and PE) Show forest plot

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

0.50 [0.09, 2.74]

1.1 Knee replacement

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

0.50 [0.09, 2.74]

2 Symptomatic DVT (proximal or distal) Show forest plot

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.03, 3.21]

2.1 Knee replacement

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.03, 3.21]

3 Symptomatic PE Show forest plot

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

1.00 [0.06, 16.13]

3.1 Knee replacement

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

1.00 [0.06, 16.13]

4 Total VTE (symptomatic and asymptomatic) Show forest plot

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

0.26 [0.14, 0.50]

4.1 Knee replacement

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

0.26 [0.14, 0.50]

5 Asymptomatic DVT Show forest plot

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

0.26 [0.13, 0.54]

5.1 Knee replacement

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

0.26 [0.13, 0.54]

6 Asymptomatic distal DVT Show forest plot

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

0.26 [0.13, 0.54]

6.1 Knee replacement

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

0.26 [0.13, 0.54]

7 All‐cause mortality Show forest plot

1

842

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.1 Knee replacement

1

842

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Bleeding ‐ major Show forest plot

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

5.05 [0.24, 105.76]

8.1 Knee replacement

1

557

Odds Ratio (M‐H, Fixed, 95% CI)

5.05 [0.24, 105.76]

Figures and Tables -
Comparison 4. Anticoagulant (chosen at investigators' discretion) versus placebo
Comparison 5. Vitamin K antagonists versus heparin

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Symptomatic VTE (DVT and PE) Show forest plot

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

1.64 [0.85, 3.16]

1.1 Hip replacement

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

1.64 [0.85, 3.16]

2 Symptomatic DVT (proximal or distal) Show forest plot

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.69, 2.68]

2.1 Hip replacement

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.69, 2.68]

3 Symptomatic PE Show forest plot

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

9.16 [0.49, 170.42]

3.1 Hip replacement

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

9.16 [0.49, 170.42]

4 Total VTE (symptomatic and asymptomatic) Show forest plot

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

1.64 [0.85, 3.16]

4.1 Hip replacement

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

1.64 [0.85, 3.16]

5 All‐cause mortality Show forest plot

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

5.07 [0.24, 105.83]

5.1 Hip replacement

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

5.07 [0.24, 105.83]

6 Bleeding ‐ major Show forest plot

1

1272

Odds Ratio (M‐H, Fixed, 95% CI)

3.87 [1.91, 7.85]

6.1 Hip replacement

1

1272

Odds Ratio (M‐H, Fixed, 95% CI)

3.87 [1.91, 7.85]

7 Bleeding ‐ minor Show forest plot

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

1.33 [0.64, 2.76]

7.1 Hip replacement

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

1.33 [0.64, 2.76]

8 Reoperation Show forest plot

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

4.60 [0.99, 21.38]

8.1 Hip replacement

1

1279

Odds Ratio (M‐H, Fixed, 95% CI)

4.60 [0.99, 21.38]

Figures and Tables -
Comparison 5. Vitamin K antagonists versus heparin
Comparison 6. DOAC versus heparin

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Symptomatic VTE (DVT and PE) Show forest plot

5

15977

Odds Ratio (M‐H, Random, 95% CI)

0.70 [0.28, 1.70]

1.1 Hip replacement

5

15977

Odds Ratio (M‐H, Random, 95% CI)

0.70 [0.28, 1.70]

2 Symptomatic DVT (proximal or distal) Show forest plot

5

15977

Odds Ratio (M‐H, Random, 95% CI)

0.60 [0.11, 3.27]

2.1 Hip replacement

5

15977

Odds Ratio (M‐H, Random, 95% CI)

0.60 [0.11, 3.27]

3 Symptomatic PE Show forest plot

5

14731

Odds Ratio (M‐H, Fixed, 95% CI)

0.91 [0.43, 1.94]

3.1 Hip replacement

5

14731

Odds Ratio (M‐H, Fixed, 95% CI)

0.91 [0.43, 1.94]

4 Total VTE (symptomatic and asymptomatic) Show forest plot

4

12447

Odds Ratio (M‐H, Random, 95% CI)

0.53 [0.29, 0.97]

4.1 Hip replacement

4

12447

Odds Ratio (M‐H, Random, 95% CI)

0.53 [0.29, 0.97]

5 Asymptomatic DVT Show forest plot

2

6559

Odds Ratio (M‐H, Random, 95% CI)

0.56 [0.19, 1.59]

5.1 Hip replacement

2

6559

Odds Ratio (M‐H, Random, 95% CI)

0.56 [0.19, 1.59]

6 Asymptomatic proximal DVT Show forest plot

1

2704

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.46, 1.15]

6.1 Hip replacement

1

2704

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.46, 1.15]

7 Asymptomatic distal DVT Show forest plot

1

2639

Odds Ratio (M‐H, Fixed, 95% CI)

1.22 [0.75, 1.99]

7.1 Hip replacement

1

2639

Odds Ratio (M‐H, Fixed, 95% CI)

1.22 [0.75, 1.99]

8 All‐cause mortality Show forest plot

5

14966

Odds Ratio (M‐H, Fixed, 95% CI)

1.63 [0.64, 4.16]

8.1 Hip replacement

5

14966

Odds Ratio (M‐H, Fixed, 95% CI)

1.63 [0.64, 4.16]

9 Adverse events Show forest plot

3

9908

Odds Ratio (M‐H, Fixed, 95% CI)

0.96 [0.88, 1.05]

9.1 Hip replacement

3

9908

Odds Ratio (M‐H, Fixed, 95% CI)

0.96 [0.88, 1.05]

10 Bleeding ‐ major Show forest plot

5

16199

Odds Ratio (M‐H, Fixed, 95% CI)

1.11 [0.79, 1.54]

10.1 Hip replacement

5

16199

Odds Ratio (M‐H, Fixed, 95% CI)

1.11 [0.79, 1.54]

11 Bleeding ‐ clinically relevant, non‐major Show forest plot

4

15241

Odds Ratio (M‐H, Fixed, 95% CI)

1.08 [0.90, 1.28]

11.1 Hip replacement

4

15241

Odds Ratio (M‐H, Fixed, 95% CI)

1.08 [0.90, 1.28]

12 Bleeding ‐ minor Show forest plot

4

11766

Odds Ratio (M‐H, Fixed, 95% CI)

0.95 [0.82, 1.10]

12.1 Hip replacement

4

11766

Odds Ratio (M‐H, Fixed, 95% CI)

0.95 [0.82, 1.10]

13 Reoperation Show forest plot

4

15241

Odds Ratio (M‐H, Fixed, 95% CI)

1.06 [0.34, 3.24]

13.1 Hip replacement

4

15241

Odds Ratio (M‐H, Fixed, 95% CI)

1.06 [0.34, 3.24]

14 Wound infection Show forest plot

2

6446

Odds Ratio (M‐H, Fixed, 95% CI)

0.89 [0.46, 1.72]

14.1 Hip replacement

2

6446

Odds Ratio (M‐H, Fixed, 95% CI)

0.89 [0.46, 1.72]

Figures and Tables -
Comparison 6. DOAC versus heparin