ACP Journal Club: review: factor Xa inhibitors reduce DVT more than LMWH in total knee or hip replacement.

Commentary VTE is an important complication of major orthopedic surgery. Advances in surgical technique, early ambulation, and early hospital discharge coupled with safer and more effective pharmacologic agents have reduced the risk for symptomatic VTE (DVT or PE). Rates of symptomatic VTE of 15% to 30% after TKR or THR before 1980 have been reduced to 1% to 2% in some recent studies (1, 2) through improved surgical techniques, earlier ambulation, and medical and mechanical thromboprophylaxis. This is an attractive market for newer anticoagulant drugs, and numerous studies now document their relative safety and efficacy compared with older anticoagulants. The duration of anticoagulation after TKR or THR has also been explored in clinical trials with patients receiving shortterm (≤ 14 d) or extended (> 21 d) anticoagulant prophylaxis (3).