Efficacy and safety of fondaparinux in elective total hip arthroplasty and hip fracture surgery: a systematic review and meta-analysis
Abstract Background As life expectancy increases, the incidence of hip fractures and the demand for total hip arthroplasties (THA) are expected to rise. This demographic shift poses significant challenges, particularly in managing post-operative complications such as venous thromboembolism (VTE), a...
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BMC
2025-05-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05950-6 |
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| author | Gonzalo Mariscal Francisco José Tarazona-Santabalbina Oliver Marin-Peña Erika Rotavista Sara Arroyo Martín María Estrella Fernández de Sevilla Jesús Gómez-Vallejo |
| author_facet | Gonzalo Mariscal Francisco José Tarazona-Santabalbina Oliver Marin-Peña Erika Rotavista Sara Arroyo Martín María Estrella Fernández de Sevilla Jesús Gómez-Vallejo |
| author_sort | Gonzalo Mariscal |
| collection | DOAJ |
| description | Abstract Background As life expectancy increases, the incidence of hip fractures and the demand for total hip arthroplasties (THA) are expected to rise. This demographic shift poses significant challenges, particularly in managing post-operative complications such as venous thromboembolism (VTE), a major cause of mortality. Despite advancements, the effectiveness of various anticoagulants, in preventing VTE post-THA or hip fracture surgery remains unclear due to conflicting study results. This study aims to thoroughly evaluate the efficacy and safety of fondaparinux in patients undergoing elective THA or hip fracture surgery. Methods This review adhered to PRISMA guidelines. Inclusion criteria targeted studies on hip surgery patients treated with fondaparinux versus placebo or other anticoagulants. Data was collected from three major databases in November 2024 using the PICOS framework, focusing on following outcomes: venous thromboembolism, mortality, and bleeding rates. Meta-analysis utilized Review Manager 5.4, and applying a fixed-effects model unless significant heterogeneity (I² ≥ 50%) was detected. Sensitivity and subgroup analyses further refined the results based on surgery type and control groups. Results Nineteen studies (n = 32534) were included in the meta-analysis. Fondaparinux significantly reduced the incidence of VTE compared to controls (OR 0.43, 95% CI 0.31 to 0.61) and low molecular weight heparins (LMWHs) (OR 0.55, 95% CI 0.41 to 0.74). The incidence of distal deep vein thrombosis (DVT) was also lower in fondaparinux group compared to LMWHs (OR 0.43, 95% CI 0.31 to 0.62). Proximal DVT showed a significant reduction overall (OR 0.33, 95% CI 0.15 to 0.75) in fondaparinux group, with no significant difference compared to enoxaparin specifically (OR 0.48, 95% CI 0.20 to 1.17). Additionally, there were no substantial differences in clinically significant bleeding. The average costs (euros, pounds and/or dollars) per patient per thromboembolic event at 90 days were lower in the fondaparinux group compared to enoxaparin, both in patients undergoing elective THA (132 vs. 216) and hip fracture surgery (339 vs. 518). Conclusion Based on the results of this meta-analysis, fondaparinux significantly reduced VTE and DVT incidence compared to LMWHs in patients undergoing elective THA and hip fracture surgery, with a similar incidence of clinically significant bleeding. Additionally, it demonstrated lower costs per thrombsoembolic event per patient than enoxaparin. |
| format | Article |
| id | doaj-art-7f6a0145b87d45f4be1ad3aa4ed3d15d |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-7f6a0145b87d45f4be1ad3aa4ed3d15d2025-08-20T03:43:10ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-05-0120111710.1186/s13018-025-05950-6Efficacy and safety of fondaparinux in elective total hip arthroplasty and hip fracture surgery: a systematic review and meta-analysisGonzalo Mariscal0Francisco José Tarazona-Santabalbina1Oliver Marin-Peña2Erika Rotavista3Sara Arroyo Martín4María Estrella Fernández de Sevilla5Jesús Gómez-Vallejo6Institute for Research on Musculoskeletal Disorders, Valencia Catholic UniversityGeriatrics Department, University Hospital of la RiberaHospital Universitario Infanta LeonorHospital 12 OctubreMedical DepartmentMedical DepartmentHospital Lozano BlesaAbstract Background As life expectancy increases, the incidence of hip fractures and the demand for total hip arthroplasties (THA) are expected to rise. This demographic shift poses significant challenges, particularly in managing post-operative complications such as venous thromboembolism (VTE), a major cause of mortality. Despite advancements, the effectiveness of various anticoagulants, in preventing VTE post-THA or hip fracture surgery remains unclear due to conflicting study results. This study aims to thoroughly evaluate the efficacy and safety of fondaparinux in patients undergoing elective THA or hip fracture surgery. Methods This review adhered to PRISMA guidelines. Inclusion criteria targeted studies on hip surgery patients treated with fondaparinux versus placebo or other anticoagulants. Data was collected from three major databases in November 2024 using the PICOS framework, focusing on following outcomes: venous thromboembolism, mortality, and bleeding rates. Meta-analysis utilized Review Manager 5.4, and applying a fixed-effects model unless significant heterogeneity (I² ≥ 50%) was detected. Sensitivity and subgroup analyses further refined the results based on surgery type and control groups. Results Nineteen studies (n = 32534) were included in the meta-analysis. Fondaparinux significantly reduced the incidence of VTE compared to controls (OR 0.43, 95% CI 0.31 to 0.61) and low molecular weight heparins (LMWHs) (OR 0.55, 95% CI 0.41 to 0.74). The incidence of distal deep vein thrombosis (DVT) was also lower in fondaparinux group compared to LMWHs (OR 0.43, 95% CI 0.31 to 0.62). Proximal DVT showed a significant reduction overall (OR 0.33, 95% CI 0.15 to 0.75) in fondaparinux group, with no significant difference compared to enoxaparin specifically (OR 0.48, 95% CI 0.20 to 1.17). Additionally, there were no substantial differences in clinically significant bleeding. The average costs (euros, pounds and/or dollars) per patient per thromboembolic event at 90 days were lower in the fondaparinux group compared to enoxaparin, both in patients undergoing elective THA (132 vs. 216) and hip fracture surgery (339 vs. 518). Conclusion Based on the results of this meta-analysis, fondaparinux significantly reduced VTE and DVT incidence compared to LMWHs in patients undergoing elective THA and hip fracture surgery, with a similar incidence of clinically significant bleeding. Additionally, it demonstrated lower costs per thrombsoembolic event per patient than enoxaparin.https://doi.org/10.1186/s13018-025-05950-6FondaparinuxEnoxaparinLow molecular weight heparinVenous thromboembolismTotal hip arthroplastyHip fracture |
| spellingShingle | Gonzalo Mariscal Francisco José Tarazona-Santabalbina Oliver Marin-Peña Erika Rotavista Sara Arroyo Martín María Estrella Fernández de Sevilla Jesús Gómez-Vallejo Efficacy and safety of fondaparinux in elective total hip arthroplasty and hip fracture surgery: a systematic review and meta-analysis Journal of Orthopaedic Surgery and Research Fondaparinux Enoxaparin Low molecular weight heparin Venous thromboembolism Total hip arthroplasty Hip fracture |
| title | Efficacy and safety of fondaparinux in elective total hip arthroplasty and hip fracture surgery: a systematic review and meta-analysis |
| title_full | Efficacy and safety of fondaparinux in elective total hip arthroplasty and hip fracture surgery: a systematic review and meta-analysis |
| title_fullStr | Efficacy and safety of fondaparinux in elective total hip arthroplasty and hip fracture surgery: a systematic review and meta-analysis |
| title_full_unstemmed | Efficacy and safety of fondaparinux in elective total hip arthroplasty and hip fracture surgery: a systematic review and meta-analysis |
| title_short | Efficacy and safety of fondaparinux in elective total hip arthroplasty and hip fracture surgery: a systematic review and meta-analysis |
| title_sort | efficacy and safety of fondaparinux in elective total hip arthroplasty and hip fracture surgery a systematic review and meta analysis |
| topic | Fondaparinux Enoxaparin Low molecular weight heparin Venous thromboembolism Total hip arthroplasty Hip fracture |
| url | https://doi.org/10.1186/s13018-025-05950-6 |
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