Wæver D, Lewis D, Saksø H, et al. - In order to prevent venous thromboembolism (VTE), direct oral anticoagulants (DOACs, previously termed novel oral anticoagulants) are used as thromboprophylaxis after major elective orthopaedic surgery, but not in the nonelective setting. The effectiveness and safety of DOACs after nonelective lower limb fracture surgery are investigated via performing a systematic review and meta-analysis. A systematic literature search of the MEDLINE, EMBASE, CINAHL, and CENTRAL databases was performed identifying eight studies meeting inclusion criteria; seven of these studies compared direct factor Xa inhibitors (XaIs) with conventional VTE prophylaxis and one study compared a direct thrombin inhibitor with conventional VTE prophylaxis. Lower rates of deep vein thrombosis and less pharmacologically attributable adverse events were reported in correlation with XaIs. DOACs differed from conventional VTE prophylaxis with respect to mortality, PE, symptomatic deep vein thrombosis, or bleeding events. Generally the results provided support for using DOACs for VTE prophylaxis following nonelective lower limb fracture surgery, such after hip fracture. The results yielded more strong support for the use of XaIs; however, there is necessity for more evidence to fully assess DOACs' role in clinical practice.