Comparing fondaparinux and low molecular weight heparin for thromboprophylaxis after hip and knee arthroplasty: a systematic review and meta-analysis

Venous thromboembolism (VTE) remains a significant cause of perioperative morbidity and mortality despite the availability of prophylactic medications. There has been a debate about which thromboprophylaxis medication, Fondaparinux or low-molecular weight heparin (LMWH), is better after hip and knee arthroplasty. We have compared these two treatment regimens in our study. Electronic databases like PubMed, Cochrane, and ScienceDirect were searched from inception to August 2024. The weighted mean difference (WMD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes were pooled using the Review Manager software version 5.4.1, and a random effects model was employed. The Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool (ROB 2.0) were used to assess the quality of the included studies. Publication bias was evaluated visually through funnel plots and statistically through Egger's regression. GRADE assessment was used to analyze the certainty of evidence. A total of 17 studies, 9 Cohorts, and 8 Randomized controlled trials (RCTs) pooling a total of 74 499 patients were included in this meta-analysis. Fondaparinux showed a statistically significant reduction in the risk of VTE [0.59; 95% confidence interval (CI): [0.48, 0.71]; P < 0.00001; I-2 = 36%] and deep venous thrombosis (DVT) (RR = 0.75, 95% CI: [0.56, 1.00]; P = 0.05; I-2 = 68%) compared to LMWH. Major bleeding (RR = 2.06, 95% CI: [1.19, 3.57]; P = 0.01; I-2 = 43%), surgical site bleeding (RR = 1.67, 95% CI: [1.04, 2.66]; P = 0.03; I-2 = 9%), and postoperative transfusions (RR = 1.07, 95% CI: [1.02, 1.12]; P = 0.004; I-2 = 0%) were significantly higher in the Fondaparinux group. Symptomatic VTE, pulmonary embolism, mortality, and operating time showed no significant difference between the two groups. In conclusion, Fondaparinux is superior to LMWH in VTE and DVT prophylaxis. However, it is associated with an increased risk of major bleeding, surgical site bleeding, and postoperative transfusions.