18 randomized controlled trials were included in this meta-analysis evaluating the efficacy and safety of newer anticoagulants compared to enoxaparin in total knee and total hip arthroplasty. Anticoagulants evaluated included apixaban, dabigatran, fondaparinux, rivaroxaban, and edoxaban. The only newer anticoagulant which failed to demonstrate a significant reduction in VTE incidence relative to enoxaparin was dabigatran at both 150mg and 220mg once daily doses. Of the remaining four, fondaparinux and rivaroxaban significant reduced VTE incidence but significantly increase clinically relevant or major bleeding event incidence, edoxaban significantly reduced VTE incidence and demonstrated similar bleeding event incidence compared to enoxaparin 20mg twice daily, and apixaban significantly lowered VTE incidence and bleeding event incidence, but only compared to enoxaparin 40mg once daily; difference compared to enoxaparin 30mg twice daily was not significant.