Anticoagulant therapy for venous thromboembolism prophylaxis in orthopaedic surgery in Japan: The evolving role of NOACs

Venous thromboembolism (VTE) is a serious complication of major orthopaedic surgery of the lower limbs. Prophylaxis therapy for VTE is important for patients who undergo orthopaedic surgery; pharmacological prophylaxis is one of the more effective therapies. In addition to the traditional anticoagulants, such as warfarin and heparin, non-vitamin K antagonist oral anticoagulants (NOACs) with VTE prophylaxis properties have recently been developed and provide a convenient option for thromboprophylaxis. Edoxaban, a direct factor Xa inhibitor, is the only NOAC approved in Japan for prophylaxis of VTE in patients undergoing lower limb orthopaedic surgery. The efficacy and safety of edoxaban for primary VTE prevention after lower limb orthopaedic surgery has been demonstrated in several phase 3 clinical studies, along with Japanese postmarketing surveillance. This article reviews Japanese studies in the area of VTE prophylaxis after orthopaedic surgery and provides an up-to-date status of the treatment including NOACs in orthopaedic surgery.