000168105 001__ 168105
000168105 005__ 20260126155509.0
000168105 0247_ $$2doi$$a10.1186/s13018-025-05950-6
000168105 0248_ $$2sideral$$a147657
000168105 037__ $$aART-2025-147657
000168105 041__ $$aeng
000168105 100__ $$aMariscal, Gonzalo
000168105 245__ $$aEfficacy and safety of fondaparinux in elective total hip arthroplasty and hip fracture surgery: a systematic review and meta-analysis
000168105 260__ $$c2025
000168105 5060_ $$aAccess copy available to the general public$$fUnrestricted
000168105 5203_ $$aBackground
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.
000168105 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttps://creativecommons.org/licenses/by/4.0/deed.es
000168105 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000168105 700__ $$aTarazona-Santabalbina, Francisco José
000168105 700__ $$aMarin-Peña, Oliver
000168105 700__ $$aRotavista, Erika
000168105 700__ $$aArroyo Martín, Sara
000168105 700__ $$aFernández de Sevilla, María Estrella
000168105 700__ $$0(orcid)0000-0002-5754-6501$$aGómez-Vallejo, Jesús$$uUniversidad de Zaragoza
000168105 7102_ $$11013$$2830$$aUniversidad de Zaragoza$$bDpto. Cirugía$$cÁrea Traumatología y Ortopedia
000168105 773__ $$g20, 538 (2025), 17$$pJournal of orthopaedic surgery and research$$tJournal of Orthopaedic Surgery and Research$$x1749-799X
000168105 8564_ $$s4231151$$uhttps://zaguan.unizar.es/record/168105/files/texto_completo.pdf$$yVersión publicada
000168105 8564_ $$s2234377$$uhttps://zaguan.unizar.es/record/168105/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000168105 909CO $$ooai:zaguan.unizar.es:168105$$particulos$$pdriver
000168105 951__ $$a2026-01-26-14:50:37
000168105 980__ $$aARTICLE