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Age older than 65 Anemia Antiplatelet therapy History of bleeding Poor anticoagulant control Alcohol abuse Cancer Diabetes Liver failure Frequent falls Nonsteroidal anti-inflammatory drug use Renal failure Recent surgery Previous stroke Thrombocytopenia Data from reference 3.
- TABLE 2
Anticoagulation agents for patients with venous thromboembolism by treatment phase
Patient Acute
(0 to ~7 days)Long-term
(~7 days to ~3 months)Extended
(~3 months to indefinite)Most patients UFH, LMWH, fondaparinux or DOACs (rivaroxaban or apixaban) DOACs (rivaroxaban, apixaban, dabigatran, or edoxaban) or VKA (warfarin) Use same anticoagulant used in long-term phase
If first or second VTE is unprovoked proximal DVT of the leg or PE with low or moderate bleeding risk
Renal failure (CrCL < 30 mL/min) or liver failure with coagulopathy UFH VKA (warfarin) Warfarin Hemodynamically unstable PE patient UFH or LMWH N/A N/A Pregnancy or cancer patient UFH or LMWH LMWH LMWH Once-daily dosing Fondaparinux or LMWH at 1.5 mg/kg/day VKA (warfarin), rivaroxaban (after 21 days) or edoxaban VKA (warfarin), edoxaban, rivaroxaban Recurrent VTE N/A If on a non-LMWH anticoagulant, convert to LMWH
If on LMWH, increase the doseIf on a non-LMWH anticoagulant, convert to LMWH
If on LMWH, increase the doseNeed for reversal agent UFH
LMWH (partially reversible)VKA (warfarin)
DabigatranWarfarin
DabigatranCrCL = creatinine clearance; DOAC = direct oral anticoagulant; DVT = deep vein thrombosis; LMWH = low-molecular-weight heparin; N/A = not applicable; PE = pulmonary embolism; UFH = unfractionated heparin; VKA = vitamin K antagonist; VTE = venous thromboembolism
Data from references 3 and 4.
Evidence Clinical relevance Absence of a temporary risk condition Strong High Pulmonary embolism or proximal deep vein thrombosis Strong High More than 2 thrombotic events Strong Restricted, consider bleeding risk during prolonged anticoagulation Male sex Strong High Residual vein thrombosis Strong Low Vena cava filter Strong High Continued estrogen use Strong High Cancer Strong High Postthrombotic syndrome Moderate Moderate Overweight Weak Low Reprinted from The Lancet (Kyrle PA, Rosendaal FR, Eichinger S. Risk assessment for recurrent venous thrombosis. Lancet 2010; 376:2032–2039). © 2010 with permission from Elsevier. https://www.sciencedirect.com/journal/the-lancet.
