Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Jun 21;13(6):e0197868.
doi: 10.1371/journal.pone.0197868. eCollection 2018.

Efficacy and safety of low-molecular-weight heparin after knee arthroscopy: A meta-analysis

Hai-Feng Huang  1   2 , Jia-Liang Tian  2 , Xian-Teng Yang  1   2 , Li Sun  2 , Ru-Yin Hu  2 , Zhi-Hui Yan  2 , Shan-Shan Li  3 , Quan Xie  4 , Xiao-Bin Tian  2
Affiliations
Meta-Analysis

Efficacy and safety of low-molecular-weight heparin after knee arthroscopy: A meta-analysis

Hai-Feng Huang et al. PLoS One. .

Abstract

Background: Venous thromboembolism (VTE) is considered a potentially serious complication of knee arthroscopy and leads to conditions such as deep venous thrombosis (DVT) and pulmonary embolism (PE). Low-molecular-weight heparin (LMWH) is widely employed in knee arthroscopy to reduce perioperative thromboembolic complications. However, the efficacy and safety of LMWH in knee arthroscopy remains unclear.

Methods: Seven randomized controlled clinical trials on LMWH in knee arthroscopy were identified and included in this meta-analysis. The main outcomes of the effectiveness (prevention of DVT and PE) and complications (death, major bleeding, and minor bleeding) of LMWH in knee arthroscopic surgery were assessed using Review Manager 5.3 software.

Results: The meta-analysis indicated that LMWH prophylaxis comprised 79% of asymptomatic DVT. No association was found in symptomatic VTE (RR: 0.90; 95% confidence interval [CI]: 0.39-2.08; P = 0.80), symptomatic DVT (RR: 0.79; 95% CI: 0.28-2.23; P = 0.66), symptomatic PE (RR: 1.36; 95% CI: 0.37-4.97; P = 0.64) and major bleeding (RR: 0.70; 95% CI: 0.12-3.95; P = 0.68) risk during LMWH prophylaxis were identified. Death was not reported in these studies. Moreover, there was a lower incidence of minor bleeding (RR: 0.64; 95% CI: 0.49 to 0.83; P = 0.001) in the control group than in the LMWH group.

Conclusion: Compared with the control group, the group treated with LMWH after knee arthroscopy was no association in reducing the symptomatic VTE rate, symptomatic DVT rate or symptomatic PE rate. The symptomatic VTE rate was 0.5% (11/2,166) in the LMWH group versus 0.6% (10/1,713) in the control group. Although the limitations of this meta-analysis cannot be ignored, the results of our study show that LMWH after knee arthroscopy is ineffective. We recommend that LMWH should not be routinely provided for knee arthroscopy.

Trial registration: ClinicalTrials.gov NCT03164746.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of the screened, excluded, and analysed publications.
Fig 2
Fig 2. Risk of bias of the selected studies according to the Cochrane Collaboration tool.
Panel A: Risk of bias graph: judgement regarding each risk of bias item presented as percentages across all studies. Panel B: Risk of bias summary: judgement regarding each risk of bias item for each study. A (+), indicates a low risk of bias; a (-), indicates a high risk of bias; and a (?), indicates an unclear risk of bias. All assessments were determined by consensus of the two independent authors.
Fig 3
Fig 3. LMWH versus control.
Asymptomatic deep vein thrombosis during follow-up.
Fig 4
Fig 4. LMWH versus control.
Symptomatic venous thromboembolism during follow-up.
Fig 5
Fig 5. LMWH versus control.
Symptomatic deep vein thrombosis during follow-up.
Fig 6
Fig 6. LMWH versus control.
Symptomatic pulmonary embolism during follow-up.
Fig 7
Fig 7. LMWH versus control.
Major bleeding during follow-up.
Fig 8
Fig 8. LMWH versus control.
Minor bleeding during follow-up.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. van Adrichem RA, Nelissen RG, Schipper IB, Rosendaal FR,Cannegieter SC. Risk of venous thrombosis after arthroscopy of the knee: results from a large population-based case-control study. J Thromb Haemost. 2015;13(8):1441–8. doi: 10.1111/jth.12996 . - DOI - PubMed
    1. Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to the global disease burden. J Thromb Haemost.2014;12(10):1580–90. doi: 10.1111/jth.12698 . - DOI - PubMed
    1. Roth VP. Prophylaxis of deepvein thrombosis in outpatients undergoing arthroscopic meniscus operation. Orthop Prax.1995; 5:345–8.
    1. Wirth T, Schneider B, Misselwitz F, Lomb M, Tüylü H, Egbring R, et al.Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (reviparin): Results of a randomized controlled trial. Arthroscopy. 2001;17(4):393–9. . - PubMed
    1. Michot M, Conen D, Holtz D, Erni D, Zumstein MD, Ruflin GB, et al. Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery: A randomized trial of prophylaxis with low—molecular weight heparin. Arthroscopy. 2002;18(3):257–63. . - PubMed

Publication types

MeSH terms

Substances

Associated data