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 dose	If on a non-LMWH anticoagulant, convert to LMWH If on LMWH, increase the dose
Need for reversal agent	UFH LMWH (partially reversible)	VKA (warfarin) Dabigatran	Warfarin Dabigatran

CrCL = 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.