168105 20260126155509.0 doi 10.1186/s13018-025-05950-6 sideral 147657 ART-2025-147657 eng Mariscal, Gonzalo Efficacy and safety of fondaparinux in elective total hip arthroplasty and hip fracture surgery: a systematic review and meta-analysis 2025 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. Access copy available to the general public Unrestricted info:eu-repo/semantics/openAccess by https://creativecommons.org/licenses/by/4.0/deed.es info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Tarazona-Santabalbina, Francisco José Marin-Peña, Oliver Rotavista, Erika Arroyo Martín, Sara Fernández de Sevilla, María Estrella Gómez-Vallejo, Jesús Universidad de Zaragoza (orcid)0000-0002-5754-6501 1013 830 Universidad de Zaragoza Dpto. Cirugía Área Traumatología y Ortopedia 20, 538 (2025), 17 Journal of orthopaedic surgery and research Journal of Orthopaedic Surgery and Research 1749-799X 4231151 http://zaguan.unizar.es/record/168105/files/texto_completo.pdf Versión publicada 2234377 http://zaguan.unizar.es/record/168105/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:168105 articulos driver 2026-01-26-14:50:37 ARTICLE