Conflict of Interest in the Assessment of Thromboprophylaxis After Total Joint Arthroplasty A Systematic Review

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-Gu, Sungnam-si, Gyeonggi-do 463-707, South Korea.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 01/2012; 94(1):27-33. DOI: 10.2106/JBJS.J.01033
Source: PubMed


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.

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    • "There has been much debate about the effect of sponsoring on study findings [33] [34] [35], and indeed, most published studies performed on the topic find an increased chance for positive conclusions from authors with a conflict of interest [36] [37] [38] [39]. "
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    • "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. "

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