Comparison of low molecular weight heparins with direct oral anticoagulants for the prevention of venous thromboembolism in major abdominopelvic surgeries: A systematic review and meta-analysis.

INTRODUCTION

Venous thromboembolism is the leading cause of postoperative death in patients undergoing oncological surgery. This systematic review and meta-analysis compares the efficacy of low-molecular-weight heparin with direct oral anticoagulants in preventing venous thromboembolism in major abdominopelvic surgeries.

METHODS

This systematic review was conducted according to a predefined protocol registered in PROSPERO (ID: 1307005) and is reported in accordance with the PRISMA 2020 statement. A search was conducted in the Cochrane Library, PubMed Central/Medline, and Google Scholar from 2000 until September 2024. The analysis was performed using RevMan 5.4.1.

RESULTS

A total of seven studies were included. There was no significant difference in incidence of venous thromboembolism (Risked Ratio = 1.77, p = 0.08), major bleeding events (RR = 0.60, p = 0.51), or pulmonary embolism incidence (Risked Ratio = 3.38, p = 0.17) among the seven included studies. A subgroup analysis of five studies performed for incidence of venous thromboembolism in gynaecological procedures also showed an insignificant difference between the two groups.

CONCLUSIONS

Direct oral anticoagulants offer efficacy and safety comparable to low-molecular-weight heparins. Further large-scale randomised controlled trials are needed to validate these findings.