British Medical Journal (BMJ) published a meta-analysis comparing clinical outcomes of use of new oral anticoagulants for prophylaxis of venous thromboembolism after total hip or knee replacement. Sixteen trials (with almost 39,000 patients) were evaluated.  Risk of thromboembolism was lower with rivaroxaban (Xarelto®), and similarly higher with enoxaparin, apixaban, and dabigatran.  Unfortunately, higher efficacy with rivaroxaban comes with the cost of increased bleeding tendency.  How do you counsel patients about risks and benefits of prophylaxis against venous thromboembolism?

BMJ editorial discusses patient preferences when selecting a therapy.  Do you evaluate this aspect of treatment with your patients and colleagues?