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 NOACs contraindicated if INR raised because of liver disease; VKA dif cult to control and INR may not re ect antithrombotic effect. Renal disease and creatinine clearance <30 mL/min VKA NOACs and LMWH contraindicated with severe renal impairment. Dosing of NOACs with levels of renal impairment differ with the NOAC and among jurisdictions. 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 NOACs, and they have demonstrated ef cacy 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 NOAC 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 Pregnancy or pregnancy risk LMWH Potential for other agents to cross the placenta Cost, coverage, licensing Varies among regions and with individual circumstances INR International Normalized Ratio; NOAC non-vitamin K oral coagulant. See Table 1 legend for expansion of other abbreviations. 