What is the role of new oral anticoagulant (NOAC) agents in preventing venous thromboembolism (VTE) in patients who undergo hip or knee arthroplasties?

NOACs (rivaroxaban,apixaban,and dabigatran) are increasingly considered for use after hip and knee arthroplasties due to their demonstrated efficacy against VTE prophylaxis with an acceptable safety profile.  When compared to enoxaparin, the risk of VTE appears to be significantly lower with rivaroxaban (relative risk 0.48), and similar with dabigatran and apixaban, while the relative risk of clinically relevant bleeding appears to be significantly higher with rivaroxaban (1.25), similar with dabigatran , and lower with apixaban (0.82) (1).

1.  Gomez-Outes, Suarez-Gea L, Vargas-Castrillon E.  Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or knee replacement: systematic review, meta-analysis, and indirect treatment. BMJ 2012;344:e3675.

What is the role of new oral anticoagulant (NOAC) agents in preventing venous thromboembolism (VTE) in patients who undergo hip or knee arthroplasties?