Version May 2024
| Factor | Preferred anticoagulant | Qualifying remarks |
| Cancer | LMWH, factor Xa inhibitors | More so if: Just diagnosed, extensive VTE, metastatic cancer, very symptomatic; vomiting; on cancer chemotherapy. |
| Initial parenteral therapy to be avoided | Rivaroxaban; apixaban | VKA, dabigatran, and edoxaban require initial parenteral therapy. |
| Once daily oral therapy preferred | Rivaroxaban; edoxaban; VKA | |
| Liver disease and coagulopathy | LMWH | DOACs contraindicated if INR raised because of liver disease; VKA difficult to control and INR may not reflect antithrombotic effect. |
| Renal disease and creatinine clearance <30 mL/min | VKA | DOACs and LMWH contraindicated with severe renal impairment. However, dosing of some DOACs can be renally adjusted, although adjustment varies with different levels of renal impairment depending on the DOAC. |
| Coronary artery disease | VKA, rivaroxaban, apixaban, edoxaban | Coronary artery events appear to occur more often with dabigatran than with VKA. This has not been seen with the other DOACs, and they have demonstrated efficacy for coronary artery disease. Antiplatelet therapy should be avoided if possible in patients on anticoagulants because of increased bleeding. |
| Dyspepsia or history of GI bleeding | VKA, apixaban | Dabigatran increased dyspepsia. Dabigatran, rivaroxaban, and edoxaban may be associated with more GI bleeding than VKA. |
| Poor compliance | VKA | INR monitoring can help to detect problems. However, some patients may be more compliant with a DOAC because it is less complex. |
| Thrombolytic therapy use | UFH infusion | Greater experience with its use in patients treated with thrombolytic therapy. |
| Reversal agent needed | VKA, UFH, DOACs | Reversal agents for DOACs may not be universally readily available. |
| Pregnancy or pregnancy risk | LMWH | Potential for other agents to cross the placenta. |
| Cost, coverage, licensing | Varies among regions and with individual circumstances |
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