Indications for Anticoagulation and Recommended Anticoagulant
| Indication | HeparinsLow-molecular-weight heparin (LMWH)Unfractionated heparin (UFH) | Vitamin K antagonists(VKAs) | Direct-acting oral anticoagulants (DOACs) |
|---|---|---|---|
| Prevention of VTE post-operatively, in hospital inpatients or in patients with high risk of recurrent VTE | Yes | No | Yes |
| Treatment of VTE | Yes | Yes | Yes |
| Treatment of VTE in disseminated malignancy | Yes | No | No |
| Treatment of unstable angina/NSTEMI | Yes | No | No |
| Atrial fibrillation (AF) | Yes | Yes | Yes |
| Prevention of mechanical-heart-valve-associated thromboembolic events and thrombosis | No | Yes | No |
| Bioprosthetic valve replacements in the first three months after surgery | No | Yes | No |
| Acute peripheral arterial occlusion | Yes (UFH) | No | No |
| As adjunct to thrombolytic therapy with alteplase | Yes (UFH) | No | No |
VTE, venous thromboembolism.
Disseminated malignancy, low-molecular-weight heparin (LMWH) preferred over vitamin K antagonists (VKAs).
Direct-acting oral anticoagulants (DOACs) not currently licensed.
Chronic kidney disease stages 4 and 5; estimated glomerular filtration rate (eGFR) <30 mL/min), warfarin or unfractionated heparin (UFH) is preferred over LMWH and DOACs because of predominantly hepatic metabolism. The DOACs are licensed in patients with eGFR 15–30 mL/min at reduced doses.