Extended-Duration Thromboprophylaxis in the Acutely Ill Medical Patient

A 74-year-old white man has been hospitalized for the past 11 days for a heart failure exacerbation (height 65 inches, weight 98 kg, BMI 36 kg/m2). He presented with lower extremity edema and shortness of breath, which has since resolved following aggressive diuresis. His past medical history includes hypertension, type 2 diabetes mellitus, history of transient ischemic attack, history of venous thromboembolism (VTE) following a hospitalization 2 years ago. Current inpatient medications include: atorvastatin 80 mg PO daily, sacubitril/valsartan 24/26 mg PO BID, carvedilol 12.5 PO BID, spironolactone 25 mg PO daily, torsemide 40 mg PO daily, dapagliflozin 10 mg PO daily, metformin 1000 mg PO BID, rivaroxaban 10 mg PO daily, enoxaparin 40 mg SubQ daily, and aspirin 81 mg PO daily.

Labs upon presentation to the emergency department included:

Sodium = 138 mEq/L
Potassium = 4.1 mEq/L
Creatinine = 1.35 mg/dL
Creatinine clearance = 42 mL/min
NT-proBNP = 8567 pg/mL
D-dimer = 0.60 mcg/mL

Labs today include:

Potassium = 4.3 mEq/L
Creatinine = 1.1 mg/dL
Creatinine clearance = 51 mL/min
eGFR = 66 mL/min/1.73m2
IMPROVE Score = 5 points (7.2% 3-month risk)
IMPROVE Bleeding Risk Score = 2.5 (<7)

Which agent could be considered to reduce the risk of VTE following hospitalization for this patient?

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