Rivaroxaban for venous thromboembolism prevention after total knee arthroplasty

Patients undergoing major orthopaedic surgery are at considerable risk for venous thromboembolism in the days and weeks after surgery. Consequently, thromboprophylaxis after major orthopaedic surgery, including total hip arthroplasty (THA) and total knee arthroplasty (TKA), is regarded as a standard element of the post-surgical care of such patients. A range of agents are available for use as thromboprophylaxis, including low molecular weight heparins, fondaparinux or warfarin. Rivaroxaban-a novel, oral direct Factor Xa inhibitor-was recently assessed as a potential alternative to current prophylactic strategies in phase III clinical trials carried out in the setting of major orthopaedic surgery. Rivaroxaban was compared to enoxaparin both in patients undergoing THA and in patients undergoing TKA. Based on the positive results of these studies, rivaroxaban has recently received marketing approval in the European Union and Canada. Here, we review the clinical database to support the use of this agent after TKA. © 2009 Springer-Verlag.