Highcock AJ, As-Sultany M, Finley R, et al. - In this study, the efficacy and safety of the 3 direct oral anticoagulants (DOACs) drugs: rivaroxaban, dabigatran, and apixaban were compared. The rate of symptomatic venous thromboembolism (VTE) and major bleeding were the primary outcomes. The wound healing problems and the requirement for a return to the theater were considered as secondary outcomes. Between 2011 and 2015, a sum of 2,431 individuals received one of the DOAC drugs as thromboprophylaxis following total hip arthroplasty (35 days) or total knee arthroplasty (14 days). The chi-squared test or Fisher’s exact test was applied to compare Binary variables between the 3 groups. For the prespecified pairwise comparison, relative risks of selected primary and secondary endpoints were also estimated. The data indicated that all 3 drugs had symptomatic VTE rates comparable with low molecular weight heparin from the published literature. Compared with apixaban and dabigatran, rivaroxaban seems to have superior efficacy in VTE prevention. There was no statistical difference for major bleeding with any of the 3 agents.