Anticoagulation management principles

Last reviewed: 5 Oct 2024
Last updated: 03 May 2024

Summary

Details

  • Key highlights
  • Algorithms and tables
  • Indications for anticoagulation
  • Indications: outcome event assessment
  • Contraindications: absolute and relative contraindications
  • Contraindications: bleeding risk assessment
  • Initiating anticoagulation in primary care
  • Initiating anticoagulation in acute inpatient care: initial therapy
  • Initiating anticoagulation in acute inpatient care: transitioning to oral therapy
  • Initiating anticoagulation in patients with HIT
  • Warfarin initiation protocols
  • Maintenance therapy: venous thromboembolism
  • Maintenance therapy: atrial fibrillation
  • Maintenance therapy: clinical re-evaluation
  • Monitoring: general principles
  • Monitoring: warfarin
  • Monitoring: parenteral anticoagulants
  • Monitoring: direct oral anticoagulants
  • Surgery/procedure in anticoagulated patient: general principles
  • Surgery/procedure in anticoagulated patient: management algorithm
  • Special populations: pregnancy
  • Special populations: breast-feeding
  • Special populations: children
  • Special populations: older patients
  • Special populations: renal impairment
  • Special populations: hepatic impairment
  • Special populations: patients on antiplatelet therapy
  • Complications: adverse effects
  • Complications: bleeding
  • Complications: management of bleeding
  • Reversal agents: general principles
  • Reversal agents: for heparins
  • Reversal agents: for warfarin
  • Reversal agents: for direct oral anticoagulants (DOACs)
  • Anticoagulants: vitamin K antagonists
  • Anticoagulants: oral direct thrombin inhibitors
  • Anticoagulants: oral factor Xa inhibitors
  • Anticoagulants: unfractionated heparin (UFH)
  • Anticoagulants: low molecular weight heparins (LMWHs)
  • Anticoagulants: parenteral factor Xa inhibitors
  • Anticoagulants: heparinoids
  • Anticoagulants: hirudins
  • Anticoagulants: argatroban
  • Patient information
  • Guidelines
Full details

Contributors

Authors

Scott M. Stevens, MD

Thrombosis Clinic

Intermountain Medical Center

Murray

UT

Professor of Medicine

Department of Medicine

Intermountain Healthcare and University of Utah

Salt Lake City

UT

Disclosures

SMS declares that he has no competing interests.

Scott C. Woller, MD

Thrombosis Clinic

Intermountain Medical Center

Murray

UT

Professor of Medicine

Department of Medicine

Intermountain Healthcare and University of Utah

Salt Lake City

UT

Disclosures

SCW declares that he has no competing interests.

Gabriel V. Fontaine, PharmD, MBA, BCCCP, BCPS

Clinical Pharmacy Manager

Critical Care and Emergency Medicine

Advanced Clinical Pharmacist

Neuroscience Critical Care

Intermountain Medical Center

Murray

UT

Associate Professor

Intermountain Healthcare and University of Utah

Salt Lake City

UT

Disclosures

GVF has received speaking and consulting honoraria from Alexion Pharmaceuticals and AstraZeneca, and consulting honoraria from Anticoagulation Forum, Chiesi, and Marinus Pharmaceuticals.

Acknowledgements

Dr Scott M. Stevens, Dr Scott C. Woller, and Dr Gabriel V. Fontaine would like to gratefully acknowledge Erin Sage Chang, a previous contributor to this topic.

Disclosures

ESC declares that she has no competing interests.

Peer reviewers

Lori-Ann Linkins, MD, MSc(Clin Epi), FRCPC

Associate Professor

Department of Medicine

McMaster University

Thrombosis Consultant

Juravinski Hospital and Cancer Centre

Hamilton

Ontario

Canada

Disclosures

LL has been reimbursed for educational lectures for Pfizer Canada (Fragmin; dalteparin) and has received lecture honoraria and research funding from Bayer, Inc (Xarelto; rivaroxaban).

Scott Kaatz, DO, MSc, FACP, SFHM

Senior Staff Hospitalist

Medical Director for Professional Development and Research

Division of Hospital Medicine

Henry Ford Hospital

Detroit

MI

Disclosures

SK has received speaker honorarium from Janssen, Boehringer-Ingelheim, Bristol Myer Squibb/Pfizer, CSL Behring, and Daiichi Sankyo; he has served as a consultant for Boehringer-Ingelheim, Bristol Myer Squibb/Pfizer, Janssen, Daiichi Sankyo, and Portola; he also is a board member (non-profit) of the Thrombosis and Hemostasis Societies of North America, the AC Forum, the National Certification Board of Anticoagulation Providers, and the National Blood Clot Alliance Medical and Scientific Advisory Board.

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