***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND VTE is the proximate cause of 100,000 deaths in the United States each year . Perioperative VTE risk among surgical patients varies by 20-fold , which highlights the importance of risk stratification to identify high-risk patients , in whom chemoprophylaxis can decrease VTE risk , and low-risk patients , for whom the risk-benefit relationship of prophylaxis may be unfavorable . METHODS We used data from a statewide surgical quality collaborative for surgical procedures performed between 2010 and 2012 . Regression-based techniques identified predictors of 90-day VTE while adjusting for procedural complexity and comorbid conditions . A weighted risk index was created and was vali date d subsequently in a separate , independent data set . RESULTS Data were available for 10,344 patients , who were allocated r and omly to a derivation or validation cohort . The 90-day VTE rate was 1.4 % ; 66.2 % of the derivation cohort and 65.5 % of the validation cohort received chemoprophylaxis . Seven risk factors were incorporated into a weighted risk index : personal history of VTE , current cancer , sepsis/septic shock/systemic inflammatory response syndrome , age≥60 years , BMI ≥40 kg/m2 , male sex , and family history of VTE . Prediction for 90-day VTE was similar in the derivation and validation cohorts ( areas under the receiver operator curve , 0.72 and 0.70 , respectively ) . An 18-fold variation in 90-day VTE rate was identified . CONCLUSIONS A weighted risk index quantifies 90-day VTE risk among surgical patients and identifies an 18-fold variation in VTE risk among the overall surgical population PURPOSE To provide current recommendations about the prophylaxis and treatment of venous thromboembolism ( VTE ) in patients with cancer . METHODS PubMed and the Cochrane Library were search ed for r and omized controlled trials , systematic review s , meta-analyses , and clinical practice guidelines from November 2012 through July 2014 . An up date committee review ed the identified abstract s. RESULTS Of the 53 publications identified and review ed , none prompted a change in the 2013 recommendations . RECOMMENDATIONS Most hospitalized patients with active cancer require thromboprophylaxis throughout hospitalization . Routine thromboprophylaxis is not recommended for patients with cancer in the outpatient setting . It may be considered for selected high-risk patients . Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and /or dexamethasone should receive prophylaxis with either low-molecular weight heparin ( LMWH ) or low-dose aspirin .  Patients undergoing major surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days . Extending prophylaxis up to 4 weeks should be considered in those undergoing major abdominal or pelvic surgery with high-risk features . LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term secondary prophylaxis ( at least 6 months ) . Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE because of limited data in patients with cancer . Anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications . Patients with cancer should be periodically assessed for VTE risk . Oncology professionals should educate patients about the signs and symptoms of VTE Background In the absence of thromboprophylaxis , patients undergoing total hip arthroplasty ( THA ) are at increased risk for venous thromboembolism ( VTE ) . The objective of this study was to compare the efficacy and safety of edoxaban with enoxaparin for the prevention of VTE after THA in Japan . Methods This was a phase 3 , double-blind , double-dummy , noninferiority study . Patients undergoing elective , unilateral primary THA were r and omized to receive edoxaban 30 mg once daily ( n = 307 ) or enoxaparin 2000 IU ( equivalent to 20 mg ) twice daily ( n = 303 ) for 11 to 14 days . The primary efficacy endpoint was the incidence of VTE . Safety endpoints included the incidence of major or clinical ly relevant nonmajor ( CRNM ) bleeding . Results The incidence of VTE , based on venography and clinical surveillance , was 2.4 % in the edoxaban group and 6.9 % in the enoxaparin group ( P < 0.001 ) . The absolute difference in the incidence of VTE was −4.5 % ( 95 % confidence interval [ CI ] : −8.6 , −0.9 ) , which was within the noninferiority margin set at 8 % for the difference and established the noninferiority of edoxaban to enoxaparin . Since the upper limit of the 95 % CI of the absolute difference was less than 0 % , the superiority of edoxaban over enoxaparin was demonstrated . The incidence of major or CRNM bleeding was 2.6 % in the edoxaban group and 3.7 % in the enoxaparin group ( P = 0.475 ) . Conclusions Oral edoxaban 30 mg once daily was superior to subcutaneous enoxaparin 2000 IU twice daily in the prevention of VTE following THA without increasing the risk for major or CRNM bleeding Objectives To evaluate the impact of preoperative sepsis on risk of postoperative arterial and venous thromboses . Design Prospect i ve cohort study using the National Surgical Quality Improvement Program data base of the American College of Surgeons ( ACS-NSQIP ) . Setting Inpatient and outpatient procedures in 374 hospitals of all types across the United States , 2005 - 12 . Participants 2 305 380 adults who underwent surgical procedures .  Main outcome measures Arterial thrombosis ( myocardial infa rct ion or stroke ) and venous thrombosis ( deep venous thrombosis or pulmonary embolism ) in the 30 days after surgery . Results Among all surgical procedures , patients with preoperative systemic inflammatory response syndrome or any sepsis had three times the odds of having an arterial or venous postoperative thrombosis ( odds ratio 3.1 , 95 % confidence interval 3.0 to 3.1 ) . The adjusted odds ratios were 2.7 ( 2.5 to 2.8 ) for arterial thrombosis and 3.3 ( 3.2 to 3.4 ) for venous thrombosis . The adjusted odds ratios for thrombosis were 2.5 ( 2.4 to 2.6 ) in patients with systemic inflammatory response syndrome , 3.3 ( 3.1 to 3.4 ) in patients with sepsis , and 5.7 ( 5.4 to 6.1 ) in patients with severe sepsis , compared with patients without any systemic inflammation . In patients with preoperative sepsis , both emergency and elective surgical procedures had a twofold increased odds of thrombosis . Conclusions Preoperative sepsis represents an important independent risk factor for both arterial and venous thromboses . The risk of thrombosis increases with the severity of the inflammatory response and is higher in both emergent and elective surgical procedures . Suspicion of thrombosis should be higher in patients with sepsis who undergo surgery INTRODUCTION This phase 3 trial compared the safety and efficacy of edoxaban , an oral direct factor Xa inhibitor , with enoxaparin sodium ( enoxaparin ) for thromboprophylaxis after total knee arthroplasty ( TKA ) in patients in Japan and Taiwan . MATERIAL S AND METHODS In this r and omized , double-blind , double-dummy study , patients received oral edoxaban 30 mg once daily beginning 6 to 24 hours postsurgery or enoxaparin 2000 IU ( equivalent to 20 mg ) subcutaneously twice daily beginning 24 to 36 hours postsurgery for 11 to 14 days . The primary efficacy endpoint was the composite of symptomatic pulmonary embolism and symptomatic and asymptomatic deep vein thrombosis . Safety endpoints included the incidence of major bleeding , clinical ly relevant non-major ( CRNM ) bleeding , major bleeding or CRNM bleeding , all bleeding events , adverse events , and adverse drug reactions . RESULTS Of 716 patients enrolled , 360 and 356 were r and omized to receive edoxaban or enoxaparin , respectively . The primary efficacy outcome occurred in 22/299 ( 7.4 % ) and 41/295 ( 13.9 % ) patients in the edoxaban and enoxaparin groups , respectively ( relative risk reduction=46.8 % ) , indicating non-inferiority ( P < 0.001 ) and superiority ( P=0.010 ) of edoxaban versus enoxaparin . In the edoxaban and enoxaparin groups , major bleeding occurred in 4/354 ( 1.1 % ) versus 1/349 ( 0.3 % ) patients ( P=0.373 ) ; major or CRNM bleeding occurred in 22/354 ( 6.2 % ) versus 13/349 ( 3.7 % ) patients ( P=0.129 ) , respectively . CONCLUSIONS Edoxaban 30 mg once daily was more effective for thromboprophylaxis than subcutaneous enoxaparin 2000 IU twice daily following TKA and demonstrated a similar incidence of bleeding events Edoxaban is a new oral direct factor Xa inhibitor . The purpose of this study was to evaluate the efficacy and safety of different doses of edoxaban for the prevention of venous thromboembolism ( VTE ) in patients undergoing elective total hip replacement . A total of 903 patients were r and omised to oral edoxaban 15 , 30 , 60 or 90 mg once daily or subcutaneous dalteparin once daily ( initial dose 2,500 IU , subsequent doses 5,000 IU ) . Both drugs were begun 6 - 8 hours postoperatively and continued for 7 - 10 days , when bilateral venography was performed . The primary efficacy endpoint was the incidence of total VTE , which included proximal and /or distal deep-vein thrombosis ( DVT ) by venography or symptomatic , objective ly confirmed DVT or pulmonary embolism during the treatment period . The primary safety outcome was the incidence of the composite of major and clinical ly relevant non-major bleeding . All venograms and bleeding events were review ed by a central independent adjudication committee blinded as to treatment allocation . Of the 903 patients r and omised , 776 were evaluable for the primary efficacy analysis . The incidences of VTE were 28.2 % , 21.2 % , 15.2 % , and 10.6 % in patients receiving edoxaban 15 , 30 , 60 and 90 mg , respectively , compared with 43.8 % in the dalteparin group ( p<0.005 ) . There was a statistically significant ( p<0.001 ) dose-response for efficacy across the edoxaban dose groups for total VTE and for major VTE . The incidence of clinical ly relevant bleeding was low and similar across the groups . Oral edoxaban once daily is effective for preventing VTE after total hip replacement INTRODUCTION Edoxaban is an oral , direct , once-daily factor Xa inhibitor . This study evaluated the safety and efficacy of edoxaban compared to subcutaneous enoxaparin in Japanese patients undergoing hip fracture surgery . MATERIAL S AND METHODS In this multicenter , r and omized , open-label , active-comparator , phase 3 trial , 92 patients were r and omized 2:1 to receive edoxaban 30 mg once daily ( n=62 ) or enoxaparin sodium ( enoxaparin ) 2000IU ( equivalent to 20 mg ) twice daily ( n=30 ) for 11 to 14days . The primary endpoints were the incidence of major or clinical ly relevant non-major ( CRNM ) bleeding and incidence of any bleeding events ( major , CRNM , or minor bleeding ) . Secondary efficacy endpoints included the incidence of thromboembolic events , venous thromboembolism-related deaths , and all-cause deaths . Additional adverse events were recorded throughout the study . RESULTS In the edoxaban and enoxaparin treatment groups , the incidence of major or CRNM bleeding was 3.4 % and 6.9 % , respectively , while any bleeding event occurred in 25.4 % and 17.2 % of patients , respectively . The incidence of thromboembolic events was 6.5 % in the edoxaban group and 3.7 % in the enoxaparin group . All events were asymptomatic deep vein thrombosis . The incidence of adverse events was 72.9 % and 82.8 % in the edoxaban and enoxaparin groups , respectively . CONCLUSIONS Compared to subcutaneous enoxaparin 2000IU twice daily , oral edoxaban 30 mg once daily demonstrated similar safety and efficacy in the prevention of thromboembolic events in Japanese patients undergoing hip fracture surgery . CLINICAL TRIALS REGISTRATION NUMBER NCT01181141 BACKGROUND Edoxaban ( the free base of DU-176b ) 
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Conclusion : This study helped to amalgamate evidence with regard to the use of edoxaban for VTE prophylaxis post-lower limb orthopedic surgery .
In line with the results of the review ed studies , edoxaban seems to be highly effective in reducing VTE post-lower limb orthopedic surgery