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How long would you anticoagulate a patient with recurrent VTE who has ongoing risk factors for intracranial bleeding?

What would be your preferred anticoagulation agent? Has a history of intracranial hemorrhages in the absence of anticoagulation due to abnormal anatomy (cavernous hemangiomas), although no recent bleeding. Initial VTE was an unprovoked subsegmental PE found 3 months prior that was not treated due to bleeding risk. Now with a provoked large saddle PE after major lung surgery, with a clot remaining despite thrombectomy.
1 Answer
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Hematology · University of Rochester School of Medicine and Dentistry
Answered on · Updated on

In general, my preferred agent outside of the inpatient setting in patients with a risk of intracranial bleeding is LMWH. In the inpatient setting, utilizing a bivalirudin or heparin gtt is most appropriate. I would monitor carefully, including potentially imaging 24 hours after the therapeutic anti...

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