Summary of practice suggestions for the 5 frequently asked questions
| Issues/questions . | Our practice . |
|---|---|
| Obesity | • We use standard-dose rivaroxaban or apixaban for VTE treatment in patients with weight >120 kg or BMI >40 kg/m2. While we do not routinely monitor anti-Xa levels, we do consider it in patients with weight >150 kg or BMI >50 kg/m2 (when available), although this practice remains investigational. |
| Renal impairment | • We avoid using DOACs in patients with CrCl <15-30 mL/min. However, apixaban might be used with close monitoring in situations where no safer alternative anticoagulants are available. • Tinzaparin can be used (when available) in patients with CrCl >20 mL/min. |
| Gastrointestinal malignancy | • We avoid DOACs in patients with unresected luminal GI cancers due to the higher risk of GI bleeding. |
| Catheter-related thrombosis | • We tailor anticoagulant for catheter-related thrombosis in patients with cancer similarly as for proximal lower extremity DVT and PE based on patient characteristics, type of cancer, and anticancer treatments. |
| Drug-drug interactions | • We consider DDIs whenever an anticoagulant is prescribed by utilizing resources such as Lexicomp, Micromedex, package inserts, and pharmacists. |
| Issues/questions . | Our practice . |
|---|---|
| Obesity | • We use standard-dose rivaroxaban or apixaban for VTE treatment in patients with weight >120 kg or BMI >40 kg/m2. While we do not routinely monitor anti-Xa levels, we do consider it in patients with weight >150 kg or BMI >50 kg/m2 (when available), although this practice remains investigational. |
| Renal impairment | • We avoid using DOACs in patients with CrCl <15-30 mL/min. However, apixaban might be used with close monitoring in situations where no safer alternative anticoagulants are available. • Tinzaparin can be used (when available) in patients with CrCl >20 mL/min. |
| Gastrointestinal malignancy | • We avoid DOACs in patients with unresected luminal GI cancers due to the higher risk of GI bleeding. |
| Catheter-related thrombosis | • We tailor anticoagulant for catheter-related thrombosis in patients with cancer similarly as for proximal lower extremity DVT and PE based on patient characteristics, type of cancer, and anticancer treatments. |
| Drug-drug interactions | • We consider DDIs whenever an anticoagulant is prescribed by utilizing resources such as Lexicomp, Micromedex, package inserts, and pharmacists. |