Direct oral anticoagulation and low molecular weight heparin for thromboprophylaxis in patients having non-cardiac surgery: advantages and disadvantages

To compare the advantages and risks of direct oral anticoagulants against low molecular weight heparin for thromboprophylaxis in individuals having non-cardiac surgery. Randomized controlled trials comparing low molecular weight heparin (prophylactic (low) or greater dose) with direct oral anticoagulants or no active therapy in adults having non-cardiac surgery were chosen. Symptomatic venous thromboembolism, symptomatic pulmonary embolism, and severe hemorrhage were the main outcomes. For network meta-analyses, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were utilized. When compared to no active treatment, direct oral anticoagulants and low molecular weight heparin reduced venous thromboembolism but probably increased severe hemorrhage to a similar level. Direct oral anticoagulants are more likely than prophylactic low molecular weight heparin to prevent symptomatic venous thromboembolism.