The choice of modalities for thromboprophylaxis after total joint arthroplasty is controversial. To address this issue, an evidence-based review of previous studies was performed. The characteristics of the studies selected for review can affect the final conclusion of an evidence-based review. One such characteristic, financial conflict of interest related to medical research, is a widespread concern. The purpose of the present study was to determine what proportion of studies on thromboprophylaxis after total joint arthroplasty were sponsored by industry and whether the assessments of thromboprophylaxis after total joint arthroplasty were associated with industry support.
We searched PubMed for prospective, original, English-language studies, published from 2004 to 2010, on thromboprophylaxis after total joint arthroplasty. The funding sources of the articles were reviewed, and qualitative conclusions regarding the modality of interest for thromboprophylaxis after total joint arthroplasty were classified as being favorable, neutral, or unfavorable.
Seventy-one eligible articles were identified; fifty-two were funded by industry, and fourteen were not. The other five studies did not include information about the funding source. A significant association was observed between the funding source and qualitative conclusions (p = 0.033). Only two (3.8%) of the fifty-two industry-sponsored studies had unfavorable conclusions, whereas three (21.4%) of the fourteen non-industry-sponsored studies indicated that, depending on the clinical scenario, the modality examined was neither effective nor safe.
Most studies on thromboprophylaxis after total joint arthroplasty are sponsored by industry. Moreover, the qualitative conclusions in those studies are favorable to the use of the sponsored prophylactic agent.
"There has been much debate about the effect of sponsoring on study findings   , and indeed, most published studies performed on the topic find an increased chance for positive conclusions from authors with a conflict of interest    . "
[Show abstract][Hide abstract] ABSTRACT: Systematic reviews of the literature are powerful tools in evidence-based medicine. However, the design and report of systematic reviews in spinal surgery contain many aspects amenable to improvement.
To discuss the issues especially relevant for systematic reviews in spinal surgery.
From our experience of systematic reviews and meta-analyses of clinical trials in spinal surgery, we infer guidance for the design and execution of systematic literature reviews.
There are many difficulties associated with the design as well as conduct of clinical trials and consequently appraising evidence in spinal surgery. New treatments should be compared with the gold standard before other comparisons are investigated. Studies should present data as thoroughly as possible regarding all subgroups and follow-up moments, possibly in supplementary material. To provide the highest level of evidence, systematic reviews should be as rigorously designed as possible.
Gathering information on clinical effectiveness in spinal surgery can be improved both at the clinical study level and at the systematic review level. Alternatives to randomized controlled trials such as comparative studies can be valuable tools on the clinical effectiveness of treatments in spinal surgery. The experience reflected in this article can support the scientific efforts in this field.
The spine journal: official journal of the North American Spine Society 08/2012; 12(8):706-13. DOI:10.1016/j.spinee.2012.08.424 · 2.43 Impact Factor
"Such data might save billions of dollars for our national health systems and prevent patients from being treated for an unnecessarily long time. However, the industry that has supported the current trials (Eriksson et al. 2008, Kakkar et al. 2008, Turpie et al. 2009, Lassen et al. 2010a, b, Lee et al. 2012) will probably neither sponsor nor initiate such studies, for obvious reasons. "
[Show abstract][Hide abstract] ABSTRACT: Total hip and total knee arthroplasties constitute the
highest risk of venous thromboembolism (VTE) comparing
to other major surgeries. VTE has a great importance
in joint replacement surgery due to its mortal
complications such as pulmoner embolism. Without
any thromboprophylaxis, the incidence of VTE in total
hip arthroplasty rises up to 60%. Taking into consideration
that VTE is responsible for 1/10 patients’ death
in hospitalized patients; prevention of VTE seems to
be more eligible, more logical and more cost-effective.
Nowadays, although there are so many different techniques
in preventing VTE, well proved data is still limited
and continuing debates about prevention technique
and timing are still going on. In recent years,
administration of oral anticoagulants has been associated
with increased preference and promising results.
Pharmacologic investigations are still going on with new
drugs providing utilization comfort, but problems are
not completely overcome. In this review, we aimed to
discuss VTE prophylaxis after total hip arthroplasty under
current literature knowledge.
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