Anticoagulants for VTE :

Types, Uses and Drug Choices

Johan Kurnianda
Division of Hematology-Medical Oncology
Department of Internal Medicine
FKKMK-UGM
Blood Adv (2020) 4 (19): 4693–4738.
VTE Management

Blood Advances, 2020, 4 , 19 : 4693-4738

 Various
Anticoagulant
 Mechanism of
Action of Various
Anticoagulants

Cells 2022, 11(20), 3214

European Heart Journal (2017) 0, 1–13
 Can DOACs be taken with meals?
• Rivaroxaban should be taken with meals to enhance absorption;
• The tablet can be crushed and taken with soft foods such as
applesauce.
• Apixaban, dabigatran, edoxaban can be taken with or without meals.
However, taking dabigatran with meals can reduce dyspepsia.
• Dabigatran capsules should not be opened, broken or chewed before
swallowing.

Thrombosis Canada, 2021

Are there any foods or beverages that need to
be avoided with DOACs?
• Unlike with warfarin, there are no known food interactions with
DOACs, so there are no food restrictions when taking these
medications.
• In addition, there is no evidence that drinking grapefruit juice affects
the effectiveness or safety of DOACs.
• In general, it is acceptable for patients taking a DOAC to drink
alcoholic beverages in moderation (e.g. a glass of wine with a meal)
as it is for patients on warfarin.

Thrombosis Canada, 2021

TABLE 1: SUGGESTED USE OF DOACS ACCORDING TO PATIENT RENAL FUNCTION

Thrombosis Canada, 2021

TABLE 1: SUGGESTED USE OF DOACS ACCORDING TO PATIENT RENAL FUNCTION

Thrombosis Canada, 2021

 TABLE 2: SUGGESTED PRE-OPERATIVE
MANAGEMENT OF PATIENTS TAKING A DOAC

Thrombosis Canada, 2021

TABLE 3. SUGGESTED GUIDE FOR POST-OPERATIVE
MANAGEMENT OF PATIENTS RECEIVING A DOAC

Thrombosis Canada, 2021

VTE Management :
Treatment Choice

Aust Prescr 2019;42:123–6

 • DOAC Uses
Based on
Renal-Function

J Am Heart Assoc. 2020;9:e017559.

 DOACS in
Patients with
Liver Disease
DOAC Uses
Based on Body
Weight

J Am Heart Assoc. 2020;9:e017559.

 Coagulopathy in Sepsis

General Aspects of Sepsis-Associated Coagulopathy, 2022

British Journal of Anaesthesia 100 (3): 288–98 (2008)
Anticoagulants in Sepsis

Healthcare 2023, 11(2), 227

Coagulopathy
in Covid-19
International Journal of Cardiology 324 (2021) 261–266
Conclusion

• Anticoagulation is the treatment of choice of VTE

• Various anticoagulants are available in the clinic
• There are many factors that will affect appropriate efficacy and
safety end points when administrating anticoagulants
• Patient comorbidities must be considered when selecting the
most appropriate anticoagulant
. Routine monitoring of renal and hepatic function, signs/symptoms of
bleeding, and parameters of compliance should be considered for all
patients