Venous thromboembolism (VTE) is a common complication after total hip and total knee arthroplasty. Currently used methods of VTE prophylaxis after these procedures have important limitations, including parenteral administration, and unpredictable plasma levels requiring frequent monitoring and dose adjustment leading to decreased patient compliance with recommended guidelines. New oral anticoagulants have been demonstrated in clinical trials to be equally efficacious to enoxaparin and allow for fixed dosing without the need for monitoring. Rivaroxaban is one of the new oral anticoagulants and is a direct factor Xa inhibitor that has demonstrated superior efficacy to that of enoxaparin. However, the data also suggest that rivaroxaban has an increased risk of bleeding compared to enoxaparin. This paper reviews the available data on the efficacy and safety of rivaroxaban for VTE prophylaxis after total hip and total knee arthroplasty. 1. Introduction Venous thromboembolism (VTE) is a common complication after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Without anticoagulant prophylaxis, symptomatic deep venous thrombosis (DVT) occurs in approximately 15%–30% of the patients undergoing THA and TKA [1, 2]. Patients undergoing TKA are at higher risk for developing DVT; however, the rate of symptomatic DVT is higher after THA [1, 3, 4]. With evolving surgical technique, and methods of preventing VTE, the rate of VTE has decreased over time [1]. Using currently accepted methods of VTE prophylaxis, the rate of symptomatic DVT is approximately 1%–3%, and the rate of pulmonary embolism (PE) is approximately 0.2%–1.1% [2, 5–8]. The efficacy of VTE prophylaxis must be weighed against the risk of bleeding complications for the patients. The most commonly used VTE chemoprophylaxes after THA and TKA are low-molecular-weight heparin (LMWH), adjusted-dose warfarin with a targeted INR of 2-3, fondaparinux, or aspirin [2]. Current VTE prophylaxis regimens have significant shortcomings. Warfarin has a slow onset of action and has a narrow therapeutic window requiring frequent monitoring. Patients taking warfarin have only a 33% compliance rate and are frequently outside the targeted INR range increasing the risk of both bleeding and VTE [9, 10]. Low-molecular-weight heparin (LMWH) and fondaparinux must be administered parenterally, which requires time and cost. Patients are less compliant with administration of these drugs due to these barriers. One study reported only 75% continued the medication after discharge [9]. However, both warfarin and LMWH have
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