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Module 6: Anticoagulation Selection

Select the appropriate anticoagulant with dosing guidance based on renal function, weight, pregnancy, cancer, and HIT history.

Pre-Test Prob.D-DimerSeverity (PESI)Category (A–E)Hestia CriteriaAnticoagulationDurationAdvanced RxSpecial Populations

Clinical Context

Current PE CategoryNot assigned yet
mL/min
kg

Anticoagulation Recommendations

ordered by preference
1
RivaroxabanPreferredDOAC — Direct Factor Xa InhibitorClass I / Level A
Loading:15 mg orally twice daily with food for 21 days
Maintenance:20 mg orally once daily with food (after 21-day loading period)
2
ApixabanDOAC — Direct Factor Xa InhibitorClass I / Level A
Loading:10 mg orally twice daily for 7 days
Maintenance:5 mg orally twice daily (after 7-day loading period)
3
EdoxabanDOAC — Direct Factor Xa InhibitorClass I / Level ANeeds 5-day parenteral lead-in
Dosing:60 mg orally once daily
4
DabigatranDOAC — Direct Thrombin InhibitorClass I / Level ANeeds 5-day parenteral lead-in
Dosing:150 mg orally twice daily
5
EnoxaparinLMWH — Low Molecular Weight HeparinClass I / Level B-R
Dosing:1 mg/kg SC every 12 hours OR 1.5 mg/kg SC once daily (both weight-based)
6
FondaparinuxSelective Factor Xa Inhibitor (Parenteral)Class I / Level B-R
Dosing:7.5 mg SC once daily (weight 50–100 kg)
7
Unfractionated Heparin (UFH)Parenteral Anticoagulant — Unfractionated HeparinClass I / Level B-NR
Loading:80 U/kg IV bolus (max 10,000 U)
Maintenance:18 U/kg/hr IV continuous infusion; titrate to aPTT 1.5–2.5× control (or anti-Xa 0.3–0.7 IU/mL)

Source: 2026 AHA/ACC PE Guideline, Section 4.2. DOACs preferred over VKA (COR I, LOE A). LMWH preferred over UFH for parenteral (COR I, LOE B-R).

IMPORTANT: This software is clinical decision support (CDS) intended for use by licensed healthcare professionals under Section 520(o)(1)(E) of the Federal Food, Drug, and Cosmetic Act. It is not intended as a medical device. All recommendations are derived from the 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism (Circulation 2026;153:e977-e1051) and must be independently verified by the treating clinician before any clinical action. AI-generated content (including extracted data and clinical notes) is produced by large language models and may contain errors, omissions, or hallucinations — clinician review is mandatory. Patient data entered into the calculator is processed entirely in the browser; AI features process data server-side under a signed HIPAA Business Associate Agreement with no data retention. AI-HEART Lab, its affiliates, and contributors assume no liability for clinical decisions made using this tool. By using this tool, you acknowledge these limitations and accept full responsibility for clinical decisions.