Venous thromboembolism (post-surgery)

Venous thromboembolism (VTE) represents the second most common medical complication in surgical patients and the third most common cause of excess mortality. Strong evidence shows that primary thromboprophylaxis is able to reduce the risk of VTE. Despite clear recommendations on the prevention of VTE in high-risk surgical patients, some of these high-risk patients remain untreated. The availability of new anticoagulant drugs has the potential to improve the prevention of VTE in high-risk patients. Currently, three new oral anticoagulant drugs, namely dabigatran, rivaroxaban and apixaban are approved for the prevention of VTE after elective total hip replacement or total knee replacement surgery. All the new compounds have shown to be at least as effective as the low-molecular-weight heparin enoxaparin, if not more effective, and with a similar safety profile. Practicing clinicians using these new drugs will need to be fully aware of their individual characteristics, there including the recommended timing of administration and the main pharmacokinetic and pharmacodynamic characteristics. More information is needed on drug interactions and on the optimal management of bleeding complications.