Anticoagulation in Unusual Clinical Scenarios: Narrative Review of the Literature

Abstract

Introduction: Anticoagulant use in specific clinical scenarios such as venous thromboembolic disease or atrial fibrillation is common, with clearly established management guidelines. However, there is currently no unified clinical guidance for managing thrombosis in unusual scenarios, presenting a significant therapeutic challenge. Objective: To review the indications for anticoagulation and their regimens in unusual clinical situations based on available evidence. Methods: A literature review was conducted from 1997 to 2022, using relevant MeSH terms for anticoagulation, oral anticoagulants, embolism, and thrombosis. Information was extracted and synthesized in a structured manner. Results: In nephrotic syndrome, warfarin is recommended, although alter-natives such as low molecular weight heparins, aspirin, or direct oral anti-coagulants exist. For intracavitary thrombus, warfarin is the drug of choice, with demonstrated equivalent efficacy to direct oral anticoagulants. For peripheral arterial disease, rivaroxaban at vascular protection dose + aspirin has shown benefit in major adverse cardiovascular outcomes depending on individual profile. Conclusions: Management of these scenarios requires proper clinical assessment and selection of the type of anticoagulant, ensuring maximum reduction of both thrombosis and bleeding risks.

Keywords

• anticoagulants
• embolism and thrombosis
• heart defects
• congenital
• nephrotic syndrome