Long-term anticoagulation options-venous thromboembolism

• For nonpregnant Pt without severe renal dysfunction or active cancer → DOAC

• For severe renal insufficiency or APLAS → warfarin. Start w/ parenteral anticoag unless ? need for lytic, catheter-based Rx or surg; bridge to INR ≥2 × ≥24 h.

• Pregnancy or unable to take oral therapy → LMWH or fondaparinux

• Cancer → DOAC (but in Pts w/ UGI cancers, more GI bleeding w/ riva) or LMWH