Highcock AJ, As-Sultany M, Finley R, et al. - In this research, the efficacy and safety of the three Direct oral anticoagulants (DOACs) drugs; rivaroxaban, dabigatran, and apixaban were assessed and compared. The primary endpoint measures included the rate of symptomatic VTE and major bleeding. Wound healing problems and the requirement for return to the theatre were considered as secondary endpoints. Between 2011 and 2015, researchers enrolled a sum of 2,431 patients who received one of the DOAC drugs as thromboprophylaxis following THA (35 days) or TKA (14 days). The chi-square test or Fisher’s exact test were applied to compare binary variables. For the pre-specified pairwise comparison, relative risks of selected primary and secondary endpoints were also estimated. The findings indicate that all three drugs had symptomatic VTE rates comparable with LMWH from the published literature. It was shown that rivaroxaban seems to have superior efficacy in VTE prevention over apixaban and dabigatran. There was no statistical difference for major bleeding with any of the three agents.