For patients with morbid obesity, standard doses of apixaban or rivaroxaban should be chosen rather than dabigatran or edoxaban.
DOACs are not recommended for VTE treatment in the acute setting following bariatric surgery but can be considered for ongoing treatment after the initial 4 weeks of therapy.
Heparins may be preferable as initial therapy in hospitalized patients with clinical instability and fluctuating renal or hepatic function, when bleeding risk is high, or when there is concern that thrombolysis may be required.
Stevens SM et al. Chest. [PMID: 34352278]
PRIMARY VTE PREVENTION & TREATEMNT IN SEVERE COVID-19
Therapeutic dosing of anticoagulation may benefit some patients who are hospitalized in the acute care setting with COVID-19, who have very elevated D-dimer values and require supplemental oxygen, and who have low bleeding risk.
Patients who are critically ill in ICUs have not been shown to benefit from therapeutic dosing.
There is no clear benefit from VTE prophylaxis for patients with COVID-19 who do not require hospitalization.
ATTACC Investigators; ACTIV-4a Investigators; REMAP-CAP Investigators; Lawler PR et al. N Engl J Med. [PMID: 34351721]
REMAP-CAP Investigators; ACTIV-4a Investigators; ATTACC Investigators; Goligher EC et al. N Engl J Med. [PMID: 34351722]
Spyropoulos AC. JAMA Intern Med. [PMID: 34617959]