Postoperative
deep vein thrombosis (DVT) occurs most often in the large veins of the legs in patients undergoing major joint
arthroplasty and major
surgical procedures. These patients remain at high risk for venous thromboembolic events. In patients undergoing total hip or
total knee arthroplasty (THA or TKA, respectively), different patterns of altered venous hemodynamics and
hypercoagulability have been found, thus the rate of distal DVT is higher than that of proximal DVT after TKA. In addition, symptomatic
venous thromboembolism (VTE) occurs earlier after TKA than THA; however, most of those events occur after hospital discharge. Consequently, extended thromboprophylaxis after discharge should be considered and is particularly important after THA owing to the prolonged risk period for VTE. Evidence-based guideline recommendations for the prevention of VTE in these patients have not been fully implemented. This is partly owing to the limitations of traditional
anticoagulants, such as the parenteral route of administration or frequent coagulation monitoring and dose adjustment, as well as concerns about
bleeding risks. The introduction of new oral agents (e.g.,
dabigatran etexilate and
rivaroxaban) may facilitate guideline adherence, particularly in the outpatient setting, owing to their
oral administration without the need for routine coagulation monitoring. Furthermore, the
direct Factor Xa inhibitor rivaroxaban has been shown to be more effective than
enoxaparin in preventing VTE.