Anticoagulation Regimen for the Acute Management of VTE
A 45-year-old man (weight 125kg) with history of hypertension, hyperlipidemia, coronary artery disease with chronic stable angina, type 2 diabetes mellitus, dyspepsia with gastric ulceration, and asthma presents to the emergency department for shortness of breath and leg pain/swelling after a 16-hour business flight. Vital signs include a blood pressure of 110/80 mmHg, heart rate of 95 beats/minutes, and respiratory rate of 20 breaths/minute. Pertinent laboratory values include a normal hemoglobin, Cr 1.0mg/dL, elevated D-dimer 2000 ng/ml, and undetectable high-sensitivity troponin. Computed tomography-angiography of the chest demonstrates bilateral segmental pulmonary emboli without evidence of right ventricular strain. Vascular ultrasound demonstrates a proximal deep vein thrombosis in the right popliteal vein. His medications include metformin, empagliflozin, pantoprazole, lisinopril, verapamil, atorvastatin, and albuterol inhaler. He has no known drug allergies. He has insurance through his employer.
Which of the following anticoagulation regimens would be most appropriate for this patient's initial management of venous thromboembolism (VTE)?