Reader Responses: Which direct oral anticoagulant would you choose for a submassive pulmonary embolism?

Here’s how readers responded to a You Make the Call question about choice of direct oral anticoagulant (DOAC) for a saddle pulmonary embolism.

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I would recommend apixaban.

Colette Hanna, MD
Beirut, Lebanon

As long as the patient completes one year of full dose DOAC, I would favor rivaroxaban due to its once-daily dosing.

Robert John Ellis, MD
Springfield, MO

Both rivaroxaban and apixaban are acceptable. Because of her body weight, I think the patient should be on a full dose. We would need to know her age and renal function, too.

Mamta Garg, PhD
Leicester, U.K.

It depends how far out from the thrombotic event the patient is. I do not have access to apixaban, so I would use rivaroxaban and possibly start with 15 mg for prophylaxis and measure levels to determine a reasonable dose.

Paul A. Ockelford, MBChB, FRACP
Auckland, New Zealand

Clinical studies with DOACs did not include patients with morbid obesity, but there is more robust data with use of rivaroxaban.

William Caceres, MD
Rio Piedras, Puerto Rico