Comparison of low molecular weight heparins with direct oral anticoagulants for the prevention of venous thromboembolism in major abdominopelvic surgeries: A systematic review and meta-analysis

INTRODUCTION: Venous thromboembolism is the leading cause of postoperative death in patients undergoing oncological surgery. This systematic review and meta-analysis compares the efficacy of low-molecular-weight heparin with direct oral anticoagulants in preventing venous thromboembolism in major abdominopelvic surgeries. METHODS: This systematic review was conducted according to a predefined protocol registered in PROSPERO (ID: 1307005) and is reported in accordance with the PRISMA 2020 statement. A search was conducted in the Cochrane Library, PubMed Central/Medline, and Google Scholar from 2000 until September 2024. The analysis was performed using RevMan 5.4.1. RESULTS: A total of seven studies were included. There was no significant difference in incidence of venous thromboembolism (Risked Ratio = 1.77, p = 0.08), major bleeding events (RR = 0.60, p = 0.51), or pulmonary embolism incidence (Risked Ratio = 3.38, p = 0.17) among the seven included studies. A subgroup analysis of five studies performed for incidence of venous thromboembolism in gynaecological procedures also showed an insignificant difference between the two groups. CONCLUSIONS: Direct oral anticoagulants offer efficacy and safety comparable to low-molecular-weight heparins. Further large-scale randomised controlled trials are needed to validate these findings.