Mechanical vs. Pharmacological Thromboprophylaxis in High-Risk Surgical Cohorts: A Network Meta-Analysis of DVT Prevention and Bleeding Trade-offs

Abstract

Background: Major surgery patients are at a notably increased risk for venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, two dangerous and potentially preventable conditions.

Objective: This study aimed to compare the efficacy and safety of mechanical, pharmacological, and combined thromboprophylaxis strategies in preventing venous thromboembolism (VTE) in high-risk surgical patients.

Methods: A Bayesian network meta-analysis was performed using data from randomized controlled trials (RCTs) and prospective cohort studies. The primary outcomes were deep vein thrombosis (DVT), pulmonary embolism (PE), and major bleeding.

Results: Combined thromboprophylaxis was the most effective in preventing DVT and PE, but it was associated with a higher risk of major bleeding. Mechanical prophylaxis provided the best safety profile, although it was less effective than combined or pharmacological prophylaxis in preventing thromboembolic events.

Conclusion: Combined prophylaxis is recommended for high-risk surgical patients, but careful consideration of bleeding risk is necessary. Further studies should explore optimal dosing regimens and bleeding risk assessment tools.