Overall treatment plan and prognosis |
Therapeutic goal (eg, palliation of symptoms related to VTE, planned oncologic intervention, immediate prognosis, hospice care) |
Planned chemotherapy |
Stage of the malignancy, overall prognosis |
Other causes for hypercoagulability (eg, bedridden, pathologic fracture, recent surgery or invasive procedures, use of hormonal agents or other medications with a high incidence of thrombotic side effects, presence of a central venous access line) |
Patient preferences, logistic, and financial issues |
Inpatient or outpatient care planned |
Who will supervise medication's use and required monitoring, if any? |
Patient preferences (eg, oral versus injectable agent, need for frequent monitoring of coagulation status) |
Treatment costs; Will the patient's insurance pay for the medication? |
Relative contraindications to anticoagulation |
Presence of central nervous system involvement |
- Central nervous system primary or metastases |
- Prior intracerebral hemorrhage |
Thrombocytopenia or bleeding diathesis present? |
Are risk factors for bleeding after use of warfarin present? (eg, impaired liver function, hepatic metastases, concomitant medication, poor nutrition) |
Selection of appropriate dosing (eg, impaired renal function, obesity, advanced age) |
Need for monitoring of treatment (eg, INR for treatment with warfarin) |
Ability or inability to reverse anticoagulation if bleeding occurs |