Timing the First Postoperative Dose of Anticoagulants Jeremy S. Paikin, MD, Jack Hirsh, MD, Noel C. Chan, MBBS, Jeffrey S. Ginsberg, MD, Jeffrey I. Weitz, MD, FCCP, John W. Eikelboom, MBBS  CHEST  Volume 148, Issue 3, Pages 587-595 (September 2015) DOI: 10.1378/chest.14-2710 Copyright © 2015 The American College of Chest Physicians Terms and Conditions

Figure 1 Efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in phase 2 studies of VTE prevention in major orthopedic surgery. A, Efficacy (composite of any DVT, objectively diagnosed pulmonary embolism [PE], and all-cause mortality) and safety (total bleeding) of OD oral rivaroxaban (dose range, 5-40 mg OD initiated 6-8 h after surgery) compared with subcutaneous enoxaparin 40 mg OD (initiated the evening before surgery). In this figure, only the results of the ODIXa-HIP study are presented; the other two studies are referred to in the text.5 B, Efficacy (composite of any DVT, symptomatic PE, and all-cause mortality) and safety (total bleeding) of oral apixaban (dose range, 5-20 mg total dose/d initiated 12-24 h after surgery and given either OD or bid) compared with subcutaneous enoxaparin 30 mg bid (initiated 12-24 h after surgery).4 C, Efficacy (VTE detected by bilateral leg venography or symptomatic events) and safety (total bleeding) of oral dabigatran (dose range, 50 mg bid, 150 mg bid, 300 mg bid, and 225 mg bid initiated 1 to 4 h after surgery compared with subcutaneous enoxaparin 40 mg OD (initiated 12 h prior to surgery).1 Solid white bar = efficacy outcome as previously defined; horizontal pattern bar = total bleeding. * and # denote statistical significance in comparison with enoxaparin and warfarin control, respectively. Enox = enoxaparin; OD = once daily. CHEST 2015 148, 587-595DOI: (10.1378/chest.14-2710) Copyright © 2015 The American College of Chest Physicians Terms and Conditions