On 2014 Mar 02, Andrea Messori commented:

The systematic review by Adam and co-workers [1] is probably the most comprehensive analysis currently available on the comparative effectiveness of new oral anticoagulants for thromboprophylaxis in patients subjected to orthopaedic surgery. One problem for readers who are interested in this issue is that PubMed now includes at least 20 meta-analyses or systematic reviews focused on this issue [1-20]. This confirms that a problem exists with multiple overlapping meta-analyses that study the same randomized trials published on the same topic[21-22]. However, there seems to be no straightforward solution to this problem.

Andrea Messori HTA Unit, Regional Health Service 50100 Firenze ITALY

References

1: Adam SS, McDuffie JR, Lachiewicz PF, Ortel TL, Williams JW Jr. Comparative effectiveness of new oral anticoagulants and standard thromboprophylaxis in patients having total hip or knee replacement: a systematic review. Ann Intern Med. 2013 Aug 20;159(4):275-84. doi: 10.7326/0003-4819-159-4-201308200-00008.Review. PubMed PMID: 24026260.

2: New Oral Anticoagulants for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation [Internet]. Ottawa (ON): Canadian Agency forDrugs and Technologies in Health; 2012. Available from http://www.ncbi.nlm.nih.gov/books/NBK169793/ PubMed PMID: 24279001.

3: Hull RD, Liang J, Bergqvist D, Yusen RD. Benefit-to-harm ratio of thromboprophylaxis for patients undergoing major orthopaedic surgery. A systematic review. Thromb Haemost. 2014 Jan 29;111(2):199-212. doi: 10.1160/TH13-08-0654. Epub 2013 Oct 24. PubMed PMID: 24154501.

4: Castellucci LA, Cameron C, Le Gal G, Rodger MA, Coyle D, Wells PS, Clifford T, Gandara E, Wells G, Carrier M. Efficacy and safety outcomes of oral anticoagulants and antiplatelet drugs in the secondary prevention of venous thromboembolism: systematic review and network meta-analysis. BMJ. 2013 Aug 30;347:f5133. doi: 10.1136/bmj.f5133. Review. PubMed PMID: 23996149; PubMed Central PMCID: PMC3758108.

5: Hamidi V, Ringerike T, Hagen G, Reikvam Å, Klemp M. New anticoagulants as thromboprophylaxis after total hip or knee replacement. Int J Technol Assess Health Care. 2013 Jul;29(3):234-43. doi: 10.1017/S0266462313000251. Epub 2013 Jun 17. PubMed PMID: 23768996.

6: Mahmoudi M, Sobieraj DM. The cost-effectiveness of oral direct factor Xa inhibitors compared with low-molecular-weight heparin for the prevention of venous thromboembolism prophylaxis in total hip or knee replacement surgery. Pharmacotherapy. 2013 Dec;33(12):1333-40. doi: 10.1002/phar.1269. Epub 2013 Apr 26. PubMed PMID: 23625693.

7: Pebanco GD, Kaiser SA, Haines ST. New pharmacologic methods to prevent venous thromboembolism in older adults: a meta-analysis. Ann Pharmacother. 2013 May;47(5):605-16. doi: 10.1345/aph.1R247. Epub 2013 Apr 19. PubMed PMID:23606553.

8: Kwok CS, Pradhan S, Yeong JK, Loke YK. Relative effects of two different enoxaparin regimens as comparators against newer oral anticoagulants: meta-analysis and adjusted indirect comparison. Chest. 2013 Aug;144(2):593-600. doi: 10.1378/chest.12-2634. PubMed PMID: 23519234.

9: Yoshida Rde A, Yoshida WB, Maffei FH, El Dib R, Nunes R, Rollo HA. Systematic review of randomized controlled trials of new anticoagulants for venous thromboembolism prophylaxis in major orthopedic surgeries, compared with enoxaparin. Ann Vasc Surg. 2013 Apr;27(3):355-69. doi:10.1016/j.avsg.2012.06.010. Epub 2013 Jan 23. Review. PubMed PMID: 23351997.

10: Hellwig T, Gulseth M. New oral therapies for the prevention and treatment of venous thromboembolism. Am J Health Syst Pharm. 2013 Jan 15;70(2):113-25. doi:10.2146/ajhp110601. Review. PubMed PMID: 23292264.

11: John M. Eisenberg Center for Clinical Decisions and Communications Science. Venous Thromboembolism Prophylaxis in Orthopedic Surgery. 2012 Aug 30. Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007-. Available from http://www.ncbi.nlm.nih.gov/books/NBK107166/ PubMed PMID: 23035277.

12: Harenberg J, Marx S, Dahl OE, Marder VJ, Schulze A, Wehling M, Weiss C. Interpretation of endpoints in a network meta-analysis of new oral anticoagulants following total hip or total knee replacement surgery. Thromb Haemost. 2012 Nov;108(5):903-12. doi: 10.1160/TH12-07-0482. Epub 2012 Sep 26. PubMed PMID: 23014668.

13: Gómez-Outes A, Terleira-Fernández AI, Suárez-Gea ML, Vargas-Castrillón E. Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or knee replacement: systematic review, meta-analysis, and indirect treatment comparisons. BMJ. 2012 Jun 14;344:e3675. doi:10.1136/bmj.e3675. Review. PubMed PMID: 22700784; PubMed Central PMCID:PMC3375207.

14: Bozzato S, Galli L, Ageno W. Thromboprophylaxis in surgical and medical patients. Semin Respir Crit Care Med. 2012 Apr;33(2):163-75. doi:10.1055/s-0032-1311795. Epub 2012 May 30. Review. PubMed PMID: 22648489.

15: Thirugnanam S, Pinto R, Cook DJ, Geerts WH, Fowler RA. Economic analyses of venous thromboembolism prevention strategies in hospitalized patients: a systematic review. Crit Care. 2012 Mar 9;16(2):R43. [Epub ahead of print] PubMed PMID: 22405349.

16: Cohen A, Drost P, Marchant N, Mitchell S, Orme M, Rublee D, Simon TA, Sutton A. The efficacy and safety of pharmacological prophylaxis of venous thromboembolism following elective knee or hip replacement: systematic review and network meta-analysis. Clin Appl Thromb Hemost. 2012 Nov;18(6):611-27. doi:10.1177/1076029612437579. Epub 2012 Mar 2. Review. PubMed PMID: 22387582.

17: Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, Colwell CW Jr; American College of Chest Physicians. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e278S-325S. doi:10.1378/chest.11-2404. PubMed PMID: 22315265; PubMed Central PMCID: PMC3278063.

18: Raskob GE, Gallus AS, Pineo GF, Chen D, Ramirez LM, Wright RT, Lassen MR. Apixaban versus enoxaparin for thromboprophylaxis after hip or knee replacement: pooled analysis of major venous thromboembolism and bleeding in 8464 patients from the ADVANCE-2 and ADVANCE-3 trials. J Bone Joint Surg Br. 2012 Feb;94(2):257-64. doi: 10.1302/0301-620X.94B2.27850. PubMed PMID: 22323697.

19: Kwong LM. Therapeutic potential of rivaroxaban in the prevention of venous thromboembolism following hip and knee replacement surgery: a review of clinical trial data. Vasc Health Risk Manag. 2011;7:461-6. doi: 10.2147/VHRM.S4441. Epub 2011 Jul 18. Review. PubMed PMID: 21822393; PubMed Central PMCID: PMC3148419.

20: Maratea D, Fadda V, Trippoli S, Messori A. Prevention of venous thromboembolism after major orthopedic surgery: indirect comparison of three new oral anticoagulants. J Thromb Haemost. 2011 Sep;9(9):1868-70. doi:10.1111/j.1538-7836.2011.04421.x. PubMed PMID: 21711443.

21: Moher D. The problem of duplicate systematic reviews. BMJ. 2013 Aug 14;347:f5040. doi: 10.1136/bmj.f5040. PubMed PMID: 23945367.

22: Siontis KC, Hernandez-Boussard T, Ioannidis JP. Overlapping meta-analyses on the same topic: survey of published studies. BMJ. 2013 Jul 19;347:f4501. doi: 10.1136/bmj.f4501. PubMed PMID: 23873947; PubMed Central PMCID: PMC3716360.

On 2014 Mar 02, Andrea Messori commented:

The systematic review by Adam and co-workers [1] is probably the most comprehensive analysis currently available on the comparative effectiveness of new oral anticoagulants for thromboprophylaxis in patients subjected to orthopaedic surgery. One problem for readers who are interested in this issue is that PubMed now includes at least 20 meta-analyses or systematic reviews focused on this issue [1-20]. This confirms that a problem exists with multiple overlapping meta-analyses that study the same randomized trials published on the same topic[21-22]. However, there seems to be no straightforward solution to this problem.

Andrea Messori HTA Unit, Regional Health Service 50100 Firenze ITALY

References

1: Adam SS, McDuffie JR, Lachiewicz PF, Ortel TL, Williams JW Jr. Comparative effectiveness of new oral anticoagulants and standard thromboprophylaxis in patients having total hip or knee replacement: a systematic review. Ann Intern Med. 2013 Aug 20;159(4):275-84. doi: 10.7326/0003-4819-159-4-201308200-00008.Review. PubMed PMID: 24026260.

2: New Oral Anticoagulants for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation [Internet]. Ottawa (ON): Canadian Agency forDrugs and Technologies in Health; 2012. Available from http://www.ncbi.nlm.nih.gov/books/NBK169793/ PubMed PMID: 24279001.

3: Hull RD, Liang J, Bergqvist D, Yusen RD. Benefit-to-harm ratio of thromboprophylaxis for patients undergoing major orthopaedic surgery. A systematic review. Thromb Haemost. 2014 Jan 29;111(2):199-212. doi: 10.1160/TH13-08-0654. Epub 2013 Oct 24. PubMed PMID: 24154501.

4: Castellucci LA, Cameron C, Le Gal G, Rodger MA, Coyle D, Wells PS, Clifford T, Gandara E, Wells G, Carrier M. Efficacy and safety outcomes of oral anticoagulants and antiplatelet drugs in the secondary prevention of venous thromboembolism: systematic review and network meta-analysis. BMJ. 2013 Aug 30;347:f5133. doi: 10.1136/bmj.f5133. Review. PubMed PMID: 23996149; PubMed Central PMCID: PMC3758108.

5: Hamidi V, Ringerike T, Hagen G, Reikvam Å, Klemp M. New anticoagulants as thromboprophylaxis after total hip or knee replacement. Int J Technol Assess Health Care. 2013 Jul;29(3):234-43. doi: 10.1017/S0266462313000251. Epub 2013 Jun 17. PubMed PMID: 23768996.

6: Mahmoudi M, Sobieraj DM. The cost-effectiveness of oral direct factor Xa inhibitors compared with low-molecular-weight heparin for the prevention of venous thromboembolism prophylaxis in total hip or knee replacement surgery. Pharmacotherapy. 2013 Dec;33(12):1333-40. doi: 10.1002/phar.1269. Epub 2013 Apr 26. PubMed PMID: 23625693.

7: Pebanco GD, Kaiser SA, Haines ST. New pharmacologic methods to prevent venous thromboembolism in older adults: a meta-analysis. Ann Pharmacother. 2013 May;47(5):605-16. doi: 10.1345/aph.1R247. Epub 2013 Apr 19. PubMed PMID:23606553.

8: Kwok CS, Pradhan S, Yeong JK, Loke YK. Relative effects of two different enoxaparin regimens as comparators against newer oral anticoagulants: meta-analysis and adjusted indirect comparison. Chest. 2013 Aug;144(2):593-600. doi: 10.1378/chest.12-2634. PubMed PMID: 23519234.

9: Yoshida Rde A, Yoshida WB, Maffei FH, El Dib R, Nunes R, Rollo HA. Systematic review of randomized controlled trials of new anticoagulants for venous thromboembolism prophylaxis in major orthopedic surgeries, compared with enoxaparin. Ann Vasc Surg. 2013 Apr;27(3):355-69. doi:10.1016/j.avsg.2012.06.010. Epub 2013 Jan 23. Review. PubMed PMID: 23351997.

10: Hellwig T, Gulseth M. New oral therapies for the prevention and treatment of venous thromboembolism. Am J Health Syst Pharm. 2013 Jan 15;70(2):113-25. doi:10.2146/ajhp110601. Review. PubMed PMID: 23292264.

11: John M. Eisenberg Center for Clinical Decisions and Communications Science. Venous Thromboembolism Prophylaxis in Orthopedic Surgery. 2012 Aug 30. Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007-. Available from http://www.ncbi.nlm.nih.gov/books/NBK107166/ PubMed PMID: 23035277.

12: Harenberg J, Marx S, Dahl OE, Marder VJ, Schulze A, Wehling M, Weiss C. Interpretation of endpoints in a network meta-analysis of new oral anticoagulants following total hip or total knee replacement surgery. Thromb Haemost. 2012 Nov;108(5):903-12. doi: 10.1160/TH12-07-0482. Epub 2012 Sep 26. PubMed PMID: 23014668.

13: Gómez-Outes A, Terleira-Fernández AI, Suárez-Gea ML, Vargas-Castrillón E. Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or knee replacement: systematic review, meta-analysis, and indirect treatment comparisons. BMJ. 2012 Jun 14;344:e3675. doi:10.1136/bmj.e3675. Review. PubMed PMID: 22700784; PubMed Central PMCID:PMC3375207.

14: Bozzato S, Galli L, Ageno W. Thromboprophylaxis in surgical and medical patients. Semin Respir Crit Care Med. 2012 Apr;33(2):163-75. doi:10.1055/s-0032-1311795. Epub 2012 May 30. Review. PubMed PMID: 22648489.

15: Thirugnanam S, Pinto R, Cook DJ, Geerts WH, Fowler RA. Economic analyses of venous thromboembolism prevention strategies in hospitalized patients: a systematic review. Crit Care. 2012 Mar 9;16(2):R43. [Epub ahead of print] PubMed PMID: 22405349.

16: Cohen A, Drost P, Marchant N, Mitchell S, Orme M, Rublee D, Simon TA, Sutton A. The efficacy and safety of pharmacological prophylaxis of venous thromboembolism following elective knee or hip replacement: systematic review and network meta-analysis. Clin Appl Thromb Hemost. 2012 Nov;18(6):611-27. doi:10.1177/1076029612437579. Epub 2012 Mar 2. Review. PubMed PMID: 22387582.

17: Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, Colwell CW Jr; American College of Chest Physicians. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e278S-325S. doi:10.1378/chest.11-2404. PubMed PMID: 22315265; PubMed Central PMCID: PMC3278063.

18: Raskob GE, Gallus AS, Pineo GF, Chen D, Ramirez LM, Wright RT, Lassen MR. Apixaban versus enoxaparin for thromboprophylaxis after hip or knee replacement: pooled analysis of major venous thromboembolism and bleeding in 8464 patients from the ADVANCE-2 and ADVANCE-3 trials. J Bone Joint Surg Br. 2012 Feb;94(2):257-64. doi: 10.1302/0301-620X.94B2.27850. PubMed PMID: 22323697.

19: Kwong LM. Therapeutic potential of rivaroxaban in the prevention of venous thromboembolism following hip and knee replacement surgery: a review of clinical trial data. Vasc Health Risk Manag. 2011;7:461-6. doi: 10.2147/VHRM.S4441. Epub 2011 Jul 18. Review. PubMed PMID: 21822393; PubMed Central PMCID: PMC3148419.

20: Maratea D, Fadda V, Trippoli S, Messori A. Prevention of venous thromboembolism after major orthopedic surgery: indirect comparison of three new oral anticoagulants. J Thromb Haemost. 2011 Sep;9(9):1868-70. doi:10.1111/j.1538-7836.2011.04421.x. PubMed PMID: 21711443.

21: Moher D. The problem of duplicate systematic reviews. BMJ. 2013 Aug 14;347:f5040. doi: 10.1136/bmj.f5040. PubMed PMID: 23945367.

22: Siontis KC, Hernandez-Boussard T, Ioannidis JP. Overlapping meta-analyses on the same topic: survey of published studies. BMJ. 2013 Jul 19;347:f4501. doi: 10.1136/bmj.f4501. PubMed PMID: 23873947; PubMed Central PMCID: PMC3716360.