Potential anticoagulant adjustments in the management of recurrent or refractory thrombosis in cancer
| Current anticoagulant . | Modification . | Example regimen . |
|---|---|---|
| Warfarin | Therapeutic LMWH | Enoxaparin 1 mg/kg BID |
| Subtherapeutic LMWH | Therapeutic LMWH | Enoxaparin 1 mg/kg BID |
| Therapeutic LMWH | 120%–125% LMWH for at least 4 weeks or Switch to DOAC or No change (± IVC filter placement) | Enoxaparin 1.2 mg/kg BID Rivaroxaban 15 mg BID × 21 days, then 20 mg daily |
| Subtherapeutic DOAC | Therapeutic DOAC or Therapeutic LMWH or No change (± IVC filter placement) | Rivaroxaban 20 mg daily Apixaban 5 mg BID |
| Therapeutic DOAC | Switch to therapeutic LMWH or 120%–125% LMWH or “Reload” DOAC | Enoxaparin 1-1.2 mg/kg BID Rivaroxaban 15 mg BID × 21 days, then 20 mg daily |
| Current anticoagulant . | Modification . | Example regimen . |
|---|---|---|
| Warfarin | Therapeutic LMWH | Enoxaparin 1 mg/kg BID |
| Subtherapeutic LMWH | Therapeutic LMWH | Enoxaparin 1 mg/kg BID |
| Therapeutic LMWH | 120%–125% LMWH for at least 4 weeks or Switch to DOAC or No change (± IVC filter placement) | Enoxaparin 1.2 mg/kg BID Rivaroxaban 15 mg BID × 21 days, then 20 mg daily |
| Subtherapeutic DOAC | Therapeutic DOAC or Therapeutic LMWH or No change (± IVC filter placement) | Rivaroxaban 20 mg daily Apixaban 5 mg BID |
| Therapeutic DOAC | Switch to therapeutic LMWH or 120%–125% LMWH or “Reload” DOAC | Enoxaparin 1-1.2 mg/kg BID Rivaroxaban 15 mg BID × 21 days, then 20 mg daily |