How do you approach inpatient DVT prophylaxis in patients already on low dose rivaroxaban 2.5 mg BID for PAD?

I suspect that the approach to this situation may vary by provider given the lack of definitive evidence. ASH 2018 guidelines provide recommendations for inpatient thromboprophylaxis in acutely or critically ill patients. Generally, prophylactic LMWH is recommended over DOACs, but guidelines acknowledge that this may not apply to those already on DOAC therapy. While data suggests similar impact on VTE-related mortality between LMWH and DOAC, available studies have suggested a higher rate of major bleeding with the use of DOAC compared to LWMH (RR,1.70; 95% CI 1.02-2.82).

Therefore, for the patient in question, I would likely recommend transitioning thromboprophylaxis to LMWH only while hospitalized. However, an alternate approach of increasi...