will work move on text and extras when I have time to add many clarifiers
amboss and uptodate slightly differing on initial options. amboss likes LMWH (e.g., enoxaparin) (preferred in pregnant and patients with normal renal function), or Fondaparinux (factor Xa inhibitor) : preferred in patients w/ a hx of HIT, or Unfractionated heparin: preferred in those w/ renal impairment or at high risk of bleeding (can quickly turn off and/or reverse w protamine)…while UTD says initial could be “For most patients with VTE who are hemodynamically stable, we suggest subcutaneous LMW heparin or fondaparinux, or the oral factor Xa inhibitors, rivaroxaban or apixaban, rather than intravenous UFH. This preference is based upon limited data that suggest that LMW heparin and fondaparinux are superior to UFH, and data that also suggest that the DOACs have similar efficacy to LMW heparin/warfarin.” in UpToDate
UTD also states this about stable, OUTPATIENT initial therapy “For most patients in whom outpatient therapy is selected, we suggest anticoagulation with either rivaroxaban or apixaban (monotherapy; ie, no need for heparin pretreatment). As alternative regimens, LMW heparin overlapped with warfarin (dual therapy) or pretreatment with LMW heparin followed by the administration of either dabigatran or edoxaban (dual therapy) are both appropriate.”
UTD also states this for transition to longer term anticoagulation after initial tx - “Factor Xa inhibitors (eg, rivaroxaban, apixaban, edoxaban) and oral direct thrombin inhibitor (ie, dabigatran) – These oral agents are our preferred anticoagulant for most hemodynamically-stable, nonpregnant patients who do not have severe renal insufficiency or active cancer (table 2). While rivaroxaban and apixaban can be administered as monotherapy, edoxaban and dabigatran are preferably administered following a five day course of heparin (ie, as dual therapy; unfractionated heparin [UFH] or LMW heparin)” UpToDate
UTD on long term therapy “Warfarin – Warfarin is our preferred anticoagulant for patients in whom factor Xa or direct thrombin inhibitors are not available and for patients with severe renal insufficiency”
think im done editing text and extras for now, would appreciate as much input as possible
great change!!