New oral anticoagulants: Their impact on efficacy and safety in patients undergoing total hip and total knee replacement and their influence on postoperative management

With the aging of the US population, elective total hip and knee replacement operations have become more prevalent, and costs to the healthcare system for these procedures are increasing rapidly. This includes costs related to treatment of venous thromboembolism, which may be a consequence of these operations if appropriate postoperative thromboprophylaxis is not administered. Among thromboprophylactic agents, the low-molecular-weight heparins, such as enoxaparin, are most commonly used in the hospital setting. Both the low-molecular-weight heparins and warfarin have management problems that may be eliminated by the use of new oral anticoagulants that are either recently approved or in phase 3 development This article explores evidence for benefits of and potential safety issues associated with the new oral anticoagulants, particularly insofar as these may affect the cost effectiveness of these agents compared with the current standard of care. (Formulary. 2012;47:197-206)