Objective: To assess the efficacy and safety of rivaroxaban thromboprophylaxis versus low weight heparins in major hip and knee arthroplasty. Methods: Systematic review in Central Cochrane Database, MEDLINE, EMBASE, LILACS, CINAHL, and referenced articles. Only randomized clinical trials were considered. The search was made until October 31, 2011. Two independent reviewers assessed the quality of articles and extracted the information. Results: 15.638 patients who underwent major orthopedic surgery were studied (nine trials). Compared with enoxaparin, thromboprophylaxis with rivaroxaban was associated with lower incidence of deep vein thrombosis, pulmonary embolism and death from any cause after major hip surgery (5.351, relative risk [RR]: 0.37; confidence interval 95% [IC 95%]: 0.29-0.48) and knee surgery (2.878, RR: 0.65; IC 95%: 0.50-0.84) without differences in bleeding events (major bleeding events in hip surgery: 7.684, RR: 1.79; IC 95%: 0.78-4.11) and knee surgery: 5.700, RR: 1.59; IC 95%: 0.77-3.27). Conclusion: Rivaroxaban thromboprophylaxis in major hip and knee arthroplasty is more effective than enoxaparin and as safe as the latter.