New oral anticoagulants for venous thromboembolism prophylaxis in orthopaedic surgery

Anticoagulant drugs reduce the risk of venous thromboembolic events after total hip and knee arthroplasty. However, the use of current drugs, such as low-molecular-weight heparins, is hampered by their subcutaneous administration. The use of a vitamin K antagonist, such as warfarin, is hampered by the required routine coagulation monitoring and dose titration to provide effective anticoagulation without an increased risk of bleeding. Numerous possible food and drug interactions must also be considered. New classes of oral anticoagulant agents have been developed that have a fixed dose, do not require coagulation monitoring, do not have food and drug interactions, and demonstrate similar or better efficacy and safety profiles when compared with current agents.