Total knee arthroplasty (TKA) is one of the most common orthopedic procedures in the United States. The number of TKAs is expected to rise significantly over the next 2 decades. One of the most common complications after TKA is venous thromboembolism (VTE), which is potentially fatal. The incidence of VTE is effectively reduced by prophylactic anticoagulants, and clinical guidelines have been developed to improve VTE management. However, current anticoagulants have limitations in terms of efficacy, safety, half-life, ease of administration, and patient adherence. Moreover, these anticoagulants require routine monitoring and dose adjustment, and potential bleeding complications represent an important concern. A new generation of anticoagulants, including recently approved rivaroxaban, is being developed to address the shortcomings of current agents. The efficacy and safety of these newer agents are comparable with those of existing ones. Rivaroxaban is the only new oral agent that is approved for use in TKA and that has demonstrated an efficacy superior to that of enoxaparin in phase 3 trials. To optimize the management of VTE prophylaxis after TKAs, orthopedic surgeons must have a thorough understanding of these new oral agents.
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