NOACs for VTE prevention in patients with lower limb fracture: a systematic review and meta-analysis
Abstract Background Novel oral anticoagulants (NOACs), including rivaroxaban, apixaban, edoxaban and dabigatran, are increasingly used for orthopaedic surgery patients. The aim of this study was to evaluate the efficacy and safety of NOACs in preventing venous thromboembolism (VTE) among patients wi...
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| Format: | Article |
| Language: | English |
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BMC
2025-07-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-06092-5 |
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| author | Bingbing Wu Lili Sun Wenying Wu Jia Cao Yuyu Chen Chengli Yan |
| author_facet | Bingbing Wu Lili Sun Wenying Wu Jia Cao Yuyu Chen Chengli Yan |
| author_sort | Bingbing Wu |
| collection | DOAJ |
| description | Abstract Background Novel oral anticoagulants (NOACs), including rivaroxaban, apixaban, edoxaban and dabigatran, are increasingly used for orthopaedic surgery patients. The aim of this study was to evaluate the efficacy and safety of NOACs in preventing venous thromboembolism (VTE) among patients with lower limb fractures. Materials and methods This meta-analysis included randomized controlled trials (RCTs). The PubMed, Embase, Cochrane Library, and Web of Science databases were comprehensively searched from inception to November 27, 2024. We evaluated the risk of bias via the Cochrane Risk of Bias Tool 2.0 (RoB 2.0). The efficacy outcomes focused on VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE), and the safety outcomes focused on major bleeding events. Two researchers screened the literature on the basis of the inclusion and exclusion criteria, evaluated the quality of the included studies, extracted the data, and conducted a meta-analysis using RevMan 5.4.1. Results The systematic search yielded 2,873 unique citations after deduplication. Ultimately, five RCTs involving 4,092 participants (2,066 participants in the NOAC group (rivaroxaban and edoxaban) and 2,026 participants in the LMWH group) were included. Pooled analysis revealed that NOACs reduced the incidence rate of DVT [OR = 0.48, 95% CI (0.23–0.97), P = 0.04; I²=10%]. However, there was no significant difference in the incidence of VTE [OR = 0.42, 95% CI (0.16–1.11), P = 0.08; I²=34%], PE [OR = 0.33, 95% CI (0.05–2.08), P = 0.24; I²=0%] or major bleeding [OR = 1.01, 95% CI (0.57–1.77), P = 0.98; I²=0%] between the LMWH group and the NOACs group. Conclusions Compared with LMWH, NOACs were associated with a lower risk of DVT in patients with lower limb fractures, although there was no statistically significant difference in preventing VTE, PE and major bleeding. Clinical trail number No. CRD42024619453. |
| format | Article |
| id | doaj-art-37c1bcf360bd40fe8c4277643ceac8b1 |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-37c1bcf360bd40fe8c4277643ceac8b12025-08-20T03:46:11ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-07-0120111210.1186/s13018-025-06092-5NOACs for VTE prevention in patients with lower limb fracture: a systematic review and meta-analysisBingbing Wu0Lili Sun1Wenying Wu2Jia Cao3Yuyu Chen4Chengli Yan5Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang UniversityDepartment of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang UniversityDepartment of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang UniversityDepartment of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang UniversityDepartment of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang UniversityDepartment of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang UniversityAbstract Background Novel oral anticoagulants (NOACs), including rivaroxaban, apixaban, edoxaban and dabigatran, are increasingly used for orthopaedic surgery patients. The aim of this study was to evaluate the efficacy and safety of NOACs in preventing venous thromboembolism (VTE) among patients with lower limb fractures. Materials and methods This meta-analysis included randomized controlled trials (RCTs). The PubMed, Embase, Cochrane Library, and Web of Science databases were comprehensively searched from inception to November 27, 2024. We evaluated the risk of bias via the Cochrane Risk of Bias Tool 2.0 (RoB 2.0). The efficacy outcomes focused on VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE), and the safety outcomes focused on major bleeding events. Two researchers screened the literature on the basis of the inclusion and exclusion criteria, evaluated the quality of the included studies, extracted the data, and conducted a meta-analysis using RevMan 5.4.1. Results The systematic search yielded 2,873 unique citations after deduplication. Ultimately, five RCTs involving 4,092 participants (2,066 participants in the NOAC group (rivaroxaban and edoxaban) and 2,026 participants in the LMWH group) were included. Pooled analysis revealed that NOACs reduced the incidence rate of DVT [OR = 0.48, 95% CI (0.23–0.97), P = 0.04; I²=10%]. However, there was no significant difference in the incidence of VTE [OR = 0.42, 95% CI (0.16–1.11), P = 0.08; I²=34%], PE [OR = 0.33, 95% CI (0.05–2.08), P = 0.24; I²=0%] or major bleeding [OR = 1.01, 95% CI (0.57–1.77), P = 0.98; I²=0%] between the LMWH group and the NOACs group. Conclusions Compared with LMWH, NOACs were associated with a lower risk of DVT in patients with lower limb fractures, although there was no statistically significant difference in preventing VTE, PE and major bleeding. Clinical trail number No. CRD42024619453.https://doi.org/10.1186/s13018-025-06092-5Lower limb fracturesNovel oral anticoagulantsVTEMeta-analysis |
| spellingShingle | Bingbing Wu Lili Sun Wenying Wu Jia Cao Yuyu Chen Chengli Yan NOACs for VTE prevention in patients with lower limb fracture: a systematic review and meta-analysis Journal of Orthopaedic Surgery and Research Lower limb fractures Novel oral anticoagulants VTE Meta-analysis |
| title | NOACs for VTE prevention in patients with lower limb fracture: a systematic review and meta-analysis |
| title_full | NOACs for VTE prevention in patients with lower limb fracture: a systematic review and meta-analysis |
| title_fullStr | NOACs for VTE prevention in patients with lower limb fracture: a systematic review and meta-analysis |
| title_full_unstemmed | NOACs for VTE prevention in patients with lower limb fracture: a systematic review and meta-analysis |
| title_short | NOACs for VTE prevention in patients with lower limb fracture: a systematic review and meta-analysis |
| title_sort | noacs for vte prevention in patients with lower limb fracture a systematic review and meta analysis |
| topic | Lower limb fractures Novel oral anticoagulants VTE Meta-analysis |
| url | https://doi.org/10.1186/s13018-025-06092-5 |
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