Table 1

Prioritized questions for optimal management of anticoagulation therapy

Prioritized questions 
1. In obese patients receiving LMWH therapy for treatment of acute VTE, should initial LMWH dose selection according to actual body weight vs dose selection based on a fixed maximum daily dose (i.e., capped dose) be used? 
2. For patients requiring administration of inhibitors or inducers of P-gp or strong inhibitors or inducers of CYP enzymes, should a DOAC or an alternative anticoagulant be used for treatment of VTE? 
3. For patients receiving maintenance VKA therapy for treatment of VTE, should point-of-care INR testing by the patient at home (PST) vs any other INR testing approach be used? 
4. For patients receiving maintenance VKA therapy for treatment of VTE, should point-of-care INR testing by the patient at home and self-adjustment of VKA dose (PSM) vs any other management approach be used? 
5. For patients receiving VKA therapy for treatment of VTE, should a shorter INR recall interval vs a longer INR recall interval be used following VKA dose adjustment due to an out-of-target-range INR? 
6. For patients receiving maintenance VKA therapy for treatment of VTE, should a longer (eg, 6-12 wk) INR recall interval vs a shorter (eg, 4 wk) INR recall interval be used during periods of stable INR control? 
7. For patients with renal dysfunction (creatinine clearance of <30 mL/min) receiving LMWH therapy for treatment of VTE, should clinicians monitor anti–factor Xa concentration to guide LMWH dose adjustment vs no such monitoring? 
8. For patients with obesity receiving LMWH therapy for treatment of VTE, should clinicians monitor anti–factor Xa concentration to guide LMWH dose adjustment vs no such monitoring? 
9. For patients receiving DOAC therapy for the treatment of VTE, should measurement of the DOAC anticoagulant effect vs no measurement of DOAC anticoagulant effect be used during management of bleeding? 
10. For patients transitioning from DOAC to VKA, should LMWH or UFH “bridging therapy” vs overlapping DOAC therapy be used until the INR is within the therapeutic range? 
11. For patients receiving anticoagulation therapy for treatment of VTE, should specialized AMS care vs care provided by the patient's regular health care provider be used for anticoagulation management? 
12. For patients receiving oral anticoagulation therapy for VTE treatment, should supplementary patient education be offered vs no supplementary patient education? 
13. For patients receiving anticoagulation therapy for VTE, should interventions to improve adherence (eg, refill reminders, INR reminders) vs usual care be used? 
14. For patients at low to moderate risk of recurrent VTE who require interruption of VKA therapy for invasive procedures, should periprocedural bridging with LMWH or UHF vs interruption of VKA therapy alone be used? 
15. For patients interrupting DOAC therapy for scheduled invasive procedures, should performing laboratory testing for DOAC anticoagulant effect be used vs interrupting DOAC therapy alone? 
16. For patients receiving VKA for treatment of VTE with INR of >4.5 but <10 and without clinically relevant bleeding, should temporary cessation of VKA plus administration of vitamin K vs temporary cessation of VKA alone be used? 
17. For patients with life-threatening bleeding during VKA treatment of VTE, should 4-factor PCC vs FFP be used, in addition to cessation of VKA and IV vitamin K? 
18. For patients with life-threatening bleeding during oral direct Xa inhibitor treatment of VTE, should cessation of direct Xa inhibitor plus reversal of the direct Xa inhibitor anticoagulant effect vs cessation of direct Xa inhibitor alone be used? 
19. For patients with life-threatening bleeding during dabigatran treatment of VTE, should cessation of dabigatran plus idarucizumab administration vs cessation of dabigatran alone be used? 
20. For patients with life-threatening bleeding during LMWH or UFH treatment of VTE, should cessation of LMWH or UFH plus protamine vs cessation of LMWH or UFH alone be used? 
21. For patients receiving treatment of VTE who survive an episode of anticoagulation therapy-related major bleeding, should resumption of oral anticoagulation therapy vs discontinuation of oral anticoagulation therapy be used? 
22. For patients with creatinine clearance of ≥50 mL/min receiving DOAC therapy for treatment of VTE, should renal function be monitored every 6 to 12 mo vs no such monitoring? 
23. For patients with creatinine clearance of <50 mL/min receiving DOAC therapy for treatment of VTE, should renal function be monitored more frequently (every 3 mo) vs no such monitoring? 
Prioritized questions 
1. In obese patients receiving LMWH therapy for treatment of acute VTE, should initial LMWH dose selection according to actual body weight vs dose selection based on a fixed maximum daily dose (i.e., capped dose) be used? 
2. For patients requiring administration of inhibitors or inducers of P-gp or strong inhibitors or inducers of CYP enzymes, should a DOAC or an alternative anticoagulant be used for treatment of VTE? 
3. For patients receiving maintenance VKA therapy for treatment of VTE, should point-of-care INR testing by the patient at home (PST) vs any other INR testing approach be used? 
4. For patients receiving maintenance VKA therapy for treatment of VTE, should point-of-care INR testing by the patient at home and self-adjustment of VKA dose (PSM) vs any other management approach be used? 
5. For patients receiving VKA therapy for treatment of VTE, should a shorter INR recall interval vs a longer INR recall interval be used following VKA dose adjustment due to an out-of-target-range INR? 
6. For patients receiving maintenance VKA therapy for treatment of VTE, should a longer (eg, 6-12 wk) INR recall interval vs a shorter (eg, 4 wk) INR recall interval be used during periods of stable INR control? 
7. For patients with renal dysfunction (creatinine clearance of <30 mL/min) receiving LMWH therapy for treatment of VTE, should clinicians monitor anti–factor Xa concentration to guide LMWH dose adjustment vs no such monitoring? 
8. For patients with obesity receiving LMWH therapy for treatment of VTE, should clinicians monitor anti–factor Xa concentration to guide LMWH dose adjustment vs no such monitoring? 
9. For patients receiving DOAC therapy for the treatment of VTE, should measurement of the DOAC anticoagulant effect vs no measurement of DOAC anticoagulant effect be used during management of bleeding? 
10. For patients transitioning from DOAC to VKA, should LMWH or UFH “bridging therapy” vs overlapping DOAC therapy be used until the INR is within the therapeutic range? 
11. For patients receiving anticoagulation therapy for treatment of VTE, should specialized AMS care vs care provided by the patient's regular health care provider be used for anticoagulation management? 
12. For patients receiving oral anticoagulation therapy for VTE treatment, should supplementary patient education be offered vs no supplementary patient education? 
13. For patients receiving anticoagulation therapy for VTE, should interventions to improve adherence (eg, refill reminders, INR reminders) vs usual care be used? 
14. For patients at low to moderate risk of recurrent VTE who require interruption of VKA therapy for invasive procedures, should periprocedural bridging with LMWH or UHF vs interruption of VKA therapy alone be used? 
15. For patients interrupting DOAC therapy for scheduled invasive procedures, should performing laboratory testing for DOAC anticoagulant effect be used vs interrupting DOAC therapy alone? 
16. For patients receiving VKA for treatment of VTE with INR of >4.5 but <10 and without clinically relevant bleeding, should temporary cessation of VKA plus administration of vitamin K vs temporary cessation of VKA alone be used? 
17. For patients with life-threatening bleeding during VKA treatment of VTE, should 4-factor PCC vs FFP be used, in addition to cessation of VKA and IV vitamin K? 
18. For patients with life-threatening bleeding during oral direct Xa inhibitor treatment of VTE, should cessation of direct Xa inhibitor plus reversal of the direct Xa inhibitor anticoagulant effect vs cessation of direct Xa inhibitor alone be used? 
19. For patients with life-threatening bleeding during dabigatran treatment of VTE, should cessation of dabigatran plus idarucizumab administration vs cessation of dabigatran alone be used? 
20. For patients with life-threatening bleeding during LMWH or UFH treatment of VTE, should cessation of LMWH or UFH plus protamine vs cessation of LMWH or UFH alone be used? 
21. For patients receiving treatment of VTE who survive an episode of anticoagulation therapy-related major bleeding, should resumption of oral anticoagulation therapy vs discontinuation of oral anticoagulation therapy be used? 
22. For patients with creatinine clearance of ≥50 mL/min receiving DOAC therapy for treatment of VTE, should renal function be monitored every 6 to 12 mo vs no such monitoring? 
23. For patients with creatinine clearance of <50 mL/min receiving DOAC therapy for treatment of VTE, should renal function be monitored more frequently (every 3 mo) vs no such monitoring? 
View Large
Close Modal
This Feature Is Available To Subscribers Only

or Create an Account

Close Modal
Close Modal