New oral anticoagulants for thromboprophylaxis after total hip or knee arthroplasty

Patients undergoing total hip or knee arthroplasty are at increased risk of venous thromboembolism (VTE). The long-term sequelae of VTE, such as post-thrombotic syndrome or pulmonary hypertension, can be debilitating with severe morbidity. Conventional anticoagulants have several short-comings: for example, warfarin requires regular coagulation monitoring and low-molecular-weight heparins are inconvenient to use because they require subcutaneous administration. The development of new anticoagulants has focused on 2 classes of compounds: direct thrombin inhibitors and direct factor Xa inhibitors. These new oral agents have shown efficacy in large randomized clinical trials and offer new, more convenient options for anticoagulation.