The Drug and Therapeutics Bulletin (DTB) features a review of dabigatran etexilate (Pradaxa®) and rivaroxaban (Xarelto®), fixed-dose oral anticoagulants licensed for the prevention of venous thromboembolism in adults who have undergone or are undergoing elective replacement of the hip or knee joints. The authors note the considerable limitations in the published evidence for both drugs, which have not been directly compared with each other, or with anticoagulants other than enoxaparin in elective major lower limb orthopaedic surgery. In addition, the published evidence to date do not seem to suggest a particular safety concern with either drug, and “the simplicity of fixed daily oral dosing without monitoring and potential cost-effectiveness of dabigatran etexilate and rivaroxaban are attractive options when patients are either not willing or not capable of self-administration of a subcutaneous alternative.” However they conclude “until more robust clinical efficacy and safety data are available for both drugs, it is advisable to use a more established alternative where possible.”