Novel oral anticoagulants for the prevention of venous thromboembolism in surgical patients

Pharmacologic prophylaxis with low-dose unfractionated heparin, low molecular weight heparin or fondaparinux has clearly demonstrated to reduce the rate of thromboembolic events in surgical patients. In the last decade, several novel oral anticoagulants have been tested in surgical patients, but only in the setting of major orthopedic surgery. Based on the results of the studies, dabigatran, rivaroxaban and apixaban have been approved by the European Medicines Agency for the prevention of venous thromboembolism after elective hip or knee replacement surgery. The novel anticoagulants represent an appealing alternative to current prophylaxis strategies that are mostly based on subcutaneous injection of low molecular weight heparin and have also been recommended by recently updated guidelines. Their role in other settings, such as hip fracture surgery, or in non-orthopedic surgery, may deserve future evaluation.