Managing a patient at risk for venous thromboembolism requires balancing all of the risks to the patient.


Factors that may affect the choice of anticoagulant:

(1) history of heparin-induced thrombocytopenia


Factors that may require reduction in the dose of the anticoagulant:

(1) reduced creatinine clearance

(2) interacting drugs causing reduced metabolism


Factors that may require an increase in the dose of the anticoagulant:

(1) hemodialysis or pheresis

(2) interacting drugs causing increased metabolism


Factors associated with an increased risk of bleeding after starting an anticoagulant:

(1) active bleeding, or have a lesion that could actively bleeding (ulcer, etc)

(2) platelet count < 100,000 per µL (quantitative platelet defect)

(3) therapy with an anti-platelet drug such as aspirin or clopidogrel (qualitative platelet defect)


An increased risk for bleeding on prophylaxis:

(1) may be a relative contraindication to anticoagulant prophylaxis and

(2) the patient may be a candidate for alternative measures (elastic stockings, etc).


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