Challenging clinical scenarios for therapeutic anticoagulation: A practical approach

Kylee L. Martens, Simone E. Dekker, Megan Crowe, Thomas G. DeLoughery, Joseph J. Shatzel

Research output: Contribution to journalReview articlepeer-review


Therapeutic anticoagulation remains a fundamental backbone in the treatment and prevention of venous thromboembolism. However, while modern therapies are increasingly safe, anticoagulation is not without risks, particularly in those at high risk for or with recent bleeding. When weighing concurrent risks and benefits in each challenging clinical scenario, an individualized assessment of the risk and acuity of bleeding should be balanced by the indication for anticoagulation. Addressing modifiable risk factors and routine re-evaluation of any changes in this balance is critical. This review outlines available data and current guidelines for the management of anticoagulation in high-risk populations, including those with thrombocytopenia, elderly and high-fall risk, inherited bleeding disorders, and in acute coronary syndrome. We also examine management after clinically significant bleeding episodes, including intracranial hemorrhage, gastrointestinal bleeding, hemoptysis, retroperitoneal bleeding, hematuria, and abnormal uterine bleeding. The aim is to provide a comprehensive review of available literature to guide clinicians in providing optimal, safe, and individualized care for patients in these challenging scenarios.

Original languageEnglish (US)
Pages (from-to)72-82
Number of pages11
JournalThrombosis research
StatePublished - Oct 2022


  • Anticoagulation management
  • Thrombosis and hemostasis

ASJC Scopus subject areas

  • Hematology


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