A Network Meta-Analysis of Thromboprophylaxis in Major Trauma Patients

Abstract

Aim: To determine the best thromboprophylaxis strategy in traumatically injured patients. Method(s): A protocol was pre-registered with PROSPERO (CRD42024545824). EMBASE, PubMed and Web of Science were searched for randomised controlled trials that involved adults with major trauma receiving any thromboprophylactic intervention between 2000 to August 2024 and the flow of papers through the review recorded in a standard PRISMA diagram. Data were extracted by two reviewers. A network of comparable papers was then constructed and a frequentist network meta-analysis using the netmeta package in R 4.3.0 was conducted with standard measures of heterogeneity used. Result(s): Six studies were included (n=26439). Enoxaparin 40mg OD was used as the reference treatment. There was no significantly increased risk of a DVT or bleeding with Aspirin 81mg BD alone (RR=1.12 95%CI 0.78,1.60; RR=0.47 95%CI 0.17,1.29). Semuloparin 20mg OD significantly decreased the risk of DVT (RR=0.66 95%CI 0.53, 0.82). There was no significant difference in mortality or pulmonary embolism (PE) between any of the interventions studied; PE was a notably rare outcome across the data set. Conclusion(s): The results show standard enoxaparin dosing is not superior to Aspirin 81mg BD as thromboprophylaxis alone. This has service delivery implications with improvements in patient experience, likely improved concordance and cost reductions to service providers if Aspirin is chosen as a favoured thromboprophylactic agent. Semuloparin produced significantly fewer DVTs, but this evidence is based on few patients (379) and so is a relatively weaker finding than the others in this analysis.