Conflict of interest in the assessment of thromboprophylaxis after total joint arthroplasty: a systematic review.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-Gu, Sungnam-si, Gyeonggi-do 463-707, South Korea.
Young-Kyun
YK
Lee
Chin Youb
CY
Chung
Kyung-Hoi
KH
Koo
Kyoung Min
KM
Lee
Hyung-Min
HM
Ji
Moon Seok
MS
Park
D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D016265:Conflict of Interest; D006801:Humans; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*