The efficacy and safety of low-molecular-weight heparin in patients undergoing knee arthroscopic surgery and anterior cruciate ligament reconstruction

Hui-Min Li; Leyi Huang; Junwei Fu; Zhicheng Tong; Wei Wei; Chong Teng

doi:10.1016/j.heliyon.2023.e19696

The efficacy and safety of low-molecular-weight heparin in patients undergoing knee arthroscopic surgery and anterior cruciate ligament reconstruction

Heliyon. 2023 Sep 6;9(9):e19696. doi: 10.1016/j.heliyon.2023.e19696. eCollection 2023 Sep.

Authors

Hui-Min Li¹, Leyi Huang¹, Junwei Fu¹, Zhicheng Tong¹, Wei Wei¹, Chong Teng¹

Affiliation

¹ Department of Orthopedics, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, China.

Abstract

Purpose: To inveatigate how effective LMWH was at preventing venous thromboembolism (VTE), major bleeding events, and minor bleeding events after simple knee arthroscopic surgery and anterior cruciate ligament reconstruction (ACLR).

Methods: We conducted a comprehensive search of PubMed, EMBASE, Cochrane Library, and the CNKI database for potentially eligible articles. The outcomes were evaluated in terms of odds ratio (OR) and the associated 95% confidence intervals (CIs). Meta-analysis was performed using the Stata software and subgroup analyses were performed based on the surgical setting including ACLR and simple knee arthroscopic surgery.

Results: A total of eight studies with 2249 patients and 1794 controls were included in this meta-analysis. In patients undergoing simple knee arthroscopic surgery, LMWH prophylaxis did not bring a significant reduction in the risk of symptomatic deep venous thrombosis (DVT), symptomatic pulmonary embolism (PE), symptomatic VTE, and did not increase the risk of major bleeding events, but did have a higher risk of minor bleeding events (OR = 1.95, 95% CI 1.34-2.84, P = 0.000) and a lower risk of asymptomatic DVT (OR = 0.14, 95% CI 0.04-0.53, P = 0.004) in comparison with non-LMWH prophylaxis. In patients undergoing ACLR, LMWH prophylaxis did not bring a significant reduction in the risk of symptomatic DVT, symptomatic PE, symptomatic VTE, and did not increase the risk of major bleeding events and minor bleeding events, but did have a lower risk of asymptomatic DVT (OR = 0.43, 95% CI 0.23-0.78, P = 0.006).

Conclusion: When compared to a control group, this meta-analysis found that LMWH had little potential benefit in preventing major VTE (symptomatic VTE, symptomatic DVT, and symptomatic PE) after simple knee arthroscopy and ACLR. As a result, LMWH should not be considered routinely in patients undergoing knee arthroscopic surgery.

Keywords: ACLR; Arthroscopic surgery; Low-molecular-weight heparin; Meta-analysis; VTE.