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Review
. 2024 Sep 18;23(1):84-94.
doi: 10.1080/20905998.2024.2395202. eCollection 2025.

Prophylactic direct oral anticoagulants vs. low molecular weight heparin after urological surgery: A systematic review and meta-analysis

M Ramadhan  1 , A AlMehandi  2 , A Al-Naseem  3 , J Hayat  1 , A Almarzouq  4
Affiliations
Review

Prophylactic direct oral anticoagulants vs. low molecular weight heparin after urological surgery: A systematic review and meta-analysis

M Ramadhan et al. Arab J Urol. .

Abstract

Purpose: To compare the outcomes of using prophylactic direct oral anti-coagulants (DOAC) and low-molecular-weight heparin (LMWH) after major urologic surgery.

Materials and methods: Systematic literature searches of MEDLINE, Embase, Web of Science, and Cochrane CENTRAL were performed up to 9 November 2023, and protocols were registered on PROSPERO (CRD42024494424). The primary outcomes were post-operative incidence of VTE and bleeding. The secondary outcomes included re-admissions and transfusions needed, post-operative complications and exploring the radical cystectomy sub-group. Outcomes were reported in 30 and 90 days where feasible with sub-group analysis.

Results: Searches yielded four studies that included 856 patients and the outcomes were reported within 30 and 90 days, with sub-analysis performed for each time-interval. We found no statistically significant differences between DOAC and LWMH within neither primary nor secondary outcomes; VTE events (RR 0.36; p = 0.06); bleeding events (RR 0.64; p = 0.45); re-admissions (RR 1.14; p = 0.39); transfusions (RR 0.42; p = 0.05) within 0-90 days and post-operative complications within 30 days (RR 0.76; p = 0.17). Similar results were found when exploring radical cystectomy sub-group: VTE risk (RR 0.42, p = 0.15), bleeding risk (RR 1.09; p = 0.90), and re-admissions to hospital (RR 1.18, p = 0.35). Limitations include small sample size, and difficult generalization to all urological surgery as most of the analyzed cohort underwent radical cystectomy.

Conclusion: DOACs may be a safe and possibly cost-effective alternative to LMWH as post-operative thromboprophylaxis. However, these findings should be interpreted with caution due to limitations; therefore, more randomized studies are needed to ascertain our findings.

Keywords: Urology; direct oral anticoagulant; low-molecular-weight heparin; radical cystectomy; surgery; venous thromboembolism.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
PRISMA flow diagram for study screening.
Figure 2.
Figure 2.
Forest plot assessing VTE events in up to 90 days.
Figure 3.
Figure 3.
Forest plot analysing bleeding events in up to 90 days.
Figure 4.
Figure 4.
Forest plot analysing re-admissions to hospital in up to 90 days.
Figure 5.
Figure 5.
Forest plot analysing transfusions needed in up to 90 days via fixed effect model.
Figure 6.
Figure 6.
Forest plot analysing post-operative complications in 30 days.
Figure 7.
Figure 7.
Forest plot analyzing VTE events in 0–90 days in radical cystectomy patients.
Figure 8.
Figure 8.
Forest plot analysing bleeding events in 0–90 days in radical cystectomy alone.
Figure 9.
Figure 9.
Risk of bias assessment using ROBINS-I.
Figure 10.
Figure 10.
Summary of Findings Table using the GRADE assessment.
See this image and copyright information in PMC

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