Few head-to-head treatment comparisons have sufficient evidence. Most studies evaluated low molecular weight heparin (LMWH), not low-risk interventions (such as aspirin and mechanical devices); most reported on total deep vein thrombosis (DVT), an outcome that includes asymptomatic DVT and is thus of unclear clinical value. In THR, LMWH has lower VTE and adverse event risks than unfractionated heparin; LMWH and aspirin have similar risks of VTE and major bleeding; direct thrombin inhibitors (DTI) have lower DVT risk than LMWH but higher major bleeding risk; and higher dose LMWH has lower DVT risk but higher major bleeding risk than lower dose.

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