The direct oral factor Xa-inhibitors are at present in clinical use as 
antithrombotics, after their efficiency and safety have been proved in clinical 
studies. Three products are actually in the market, rivaroxaban (Xarelto®) 
apixaban (Eliquis®) and edoxaban (Lixiana®). Efficacy and safety have been 
tested for rivaroxaban and apixaban in large study programmes with more than 
60'000 patients each. For edoxaban large phase III studies are under way. Based 
on these data rivaroxaban was registered in the EU and CH for primary 
prophylaxis against thrombosis after major orthopaedic surgery, such as hip- and 
knee-joint protheses, for treatment and prophylaxis of deep vein thrombosis and 
pulmonary embolism and for prophylaxis against thromboembolic stroke in patients 
with atrial fibrillation. Apixaban is presently registered in the EU and CH for 
prophylaxis against thrombosis after major orthopaedic surgery, Edoxaban is 
registered only in Japan for the same indication. These products have been shown 
to be non-inferior or superior compared with vitamin K antagonists or 
low-molecular weight heparins, they are administered once or twice a day, they 
do not need laboratory monitoring. But they have disadvantages also, they depend 
on renal clearance, they can interact with other medicaments and they lack a 
specific antidote. In total, though, they are considered as a progress for the 
appropriate patients in terms of quality of treatment.