Table 1. Anticoagulants for prophylaxis... | American Society of Hematology

Table 1.

Anticoagulants for prophylaxis and treatment of AT deficiency

Class	Drug	Specific consideration
Class	Drug	Diagnostic AT determination	Prophylaxis and treatment*
UFH		Decrease in AT during continuous infusion⁴³	Heparin resistance possible; if no adequate increase at usual UFH dose, increase dose or consider AT replacement; be aware of bleeding risk with high dose of UFH and AT replacement
LMWH	Dalteparin, enoxaparin, tinzaparin, nadroparin, bemiparin	Decrease unlikely but cannot be excluded completely⁵⁰	Currently often used; seems effective by experience; dose has not been tested in clinical trials; anti-Xa measurement may not reflect anticoagulant effect but has been used
Indirect factor Xa inhibitor	Fondaparinux	No experience	Almost no data
VKA	Warfarin, acenocoumarol, phenprocoumon	All AT tests possible	Effective
DOAC
Thrombin inhibitor	Dabigatran	Falsely high levels if tested with FIIa-based assays⁸⁰	Most likely effective; no data
Factor Xa inhibitor	Apixaban, edoxaban, rivaroxaban	Falsely high levels if tested with FXa-based assays⁸¹	Most likely effective; only rare cases

Class	Drug	Specific consideration
Class	Drug	Diagnostic AT determination	Prophylaxis and treatment*
UFH		Decrease in AT during continuous infusion⁴³	Heparin resistance possible; if no adequate increase at usual UFH dose, increase dose or consider AT replacement; be aware of bleeding risk with high dose of UFH and AT replacement
LMWH	Dalteparin, enoxaparin, tinzaparin, nadroparin, bemiparin	Decrease unlikely but cannot be excluded completely⁵⁰	Currently often used; seems effective by experience; dose has not been tested in clinical trials; anti-Xa measurement may not reflect anticoagulant effect but has been used
Indirect factor Xa inhibitor	Fondaparinux	No experience	Almost no data
VKA	Warfarin, acenocoumarol, phenprocoumon	All AT tests possible	Effective
DOAC
Thrombin inhibitor	Dabigatran	Falsely high levels if tested with FIIa-based assays⁸⁰	Most likely effective; no data
Factor Xa inhibitor	Apixaban, edoxaban, rivaroxaban	Falsely high levels if tested with FXa-based assays⁸¹	Most likely effective; only rare cases

DOAC, direct oral anticoagulant; UFH, unfractionated heparin; VKA, vitamin K antagonist.

Literature on these considerations is cited in the text.