Oral factor Xa inhibitors are attractive options for preventing post-op thromboembolic disease, since they are given at a fixed dose and do not require serum monitoring. In this randomized trial, 3195 post-op total knee replacement patients were randomized to apixaban (2.5mg po BID) or enoxaparin (30mg SQ BID) for 10-14 days. The primary outcome (DVT, PE, or death) occurred in 9% in each group, with less bleeding in the apixaban group (3% vs 4%). Apixaban is a promising new oral agent for post-op thromboembolism prevention, pending FDA approval (abstract).
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