a rct study of rivaroxaban lowmolecularweight heparin and sequential medication regimens for the prevention of venous thrombosis after internal fixation of hip fracture the guidelines for the prevention of venous thromboembolism in orthopedic surgeries have reached a consensus on the postoperative conventional anticoagulation however the choice of anticoagulant drugs is yet controversial the use of the drug rivaroxaban is expensive since the compliance of patients with lowmolecularweight heparin is considerably low a costeffective efficacious and convenient anticoagulant program is essential the present study investigated the efficacy safety patient compliance and costeffectiveness of lowmolecularweight heparin with sequential rivaroxaban anticoagulant therapy in patients with a hip fracture following internal fixation a total of 287 patients with hip fractures were randomized into three groups rivaroxaban alone enoxaparin alone and enoxaparin followed by rivaroxaban the primary endpoint was the incidence of postoperative vte whereas the secondary endpoints were the compliance and treatment costs adverse reactions included bleeding and wound complications the incidences of vte were 521 1474 and 1042 in the rivaroxaban lowmolecularweight heparin and sequential therapy groups respectively the vterelated mortality rates were 0 105 and 104 the average hospital stay was 128157 and 115d whereas the compliance rates of the three groups were 823 716 and 885 respectively the incidences of adverse incisions were 146 42 and 63 for the three groups examined the effects and the incidence of postoperative bleeding in the treatment of lowmolecularweight heparin followed by rivaroxaban did not differ significantly from that of rivaroxaban alone however the postoperative drainage the cost of treatment and the incidence of vte reduced significantly whereas the incidences of adverse incisions and the patient compliance were increasedtrial registration chictrinr17010495