A comparison of the efficacy and safety of direct oral anticoagulants with low molecular weight heparin for venous thromboembolism prophylaxis after total hip arthroplasty : a systematic review and meta-analysis.

What was studied

This study looked at blood clots after planned hip replacement surgery. It compared DOACs, which are taken by mouth, with LMWH. Both are drugs given to help stop clots. The team pooled results from earlier trials. In these trials, people were put into groups by chance. They searched for trials up to 13 December 2025.

What they found

The review took in 22 trials with 28,112 people. Clots were less common with DOACs than with LMWH. This was mainly due to fewer clots in deep veins. This still held when only drugs licensed in the UK were used. Overall, bleeding was more common with DOACs. But with UK-licensed drugs and doses, bleeding did not differ. The need for repeat surgery did not differ between groups. Deaths did not differ either.

What it means for patients

The authors say DOACs lower the risk of clots after hip surgery. They say this holds for the drugs and doses licensed in the UK. For those, they found no rise in bleeding. They also think a switch to DOACs could save the NHS money each year.

Why it is not certain yet

When all drugs were counted, bleeding was higher with DOACs. With UK-licensed drugs and doses alone, bleeding did not differ. The authors say new trials are needed. These should compare UK-licensed DOACs with LMWH. They should look at both safety and how well the drugs work. They should also use modern plans for recovery after surgery. A review can only be as good as the studies in it.

Source

A comparison of the efficacy and safety of direct oral anticoagulants with low molecular weight heparin for venous thromboembolism prophylaxis after total hip arthroplasty : a systematic review and meta-analysis.

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