Anticoagulant regimen	Preferred timing with respect to cancer therapy	Drugs and dosing	Reversibility	Drug-drug interactions	Reduced renal function	Reduced liver function	Cost	Comments
VKAs	Before and after	Coumadin, dosing according to INR	Vitamin K, fresh frozen plasma or prothrombin complex concentrate	+++	Preferred if severe end-stage renal disease without haemodialysis	Not required	Low	Inconvenience owing to the need for recurrent INR checks
LMWH	During	Enoxaparin 1 mg/kg subcutaneously twice daily; dalteparin 200 U/kg subcutaneously daily	Protamine (but unlike with unfractionated heparin, it does not completely abolish the anti-factor Xa activity of LMWH)	+	Caution if eGFR <30 ml/min; monitor factor Xa levels	Not required	High	Heparin-induced thrombocytopenia; discomfort with injections; challenging long-term treatment
NOACs	Before and after	Rivaroxaban 20 mg orally daily; endoxaban 60 mg orally daily; dabigatran 150 mg orally twice daily; apixaban 5 mg orally twice daily	Idarucizumab (Praxbind) for dabigatran; andexanet alfa (Andexxa), if available, for apixaban or rivaroxaban; or four-factor prothrombin complex concentrate for all other NOACs	+++	Reduce rivaroxaban dosage to 15 mg daily; reduce endoxaban dosage to 30 mg daily if eGFR is 15–50 ml/min; reduce dabigatran dosage to 75 mg twice daily if eGFR is 15–30 ml/min; reduce apixaban dosage to 2.5 mg twice daily if serum creatinine level is ≥1.5 mg/dl and either age ≥80 years or weight ≤60 kg	Not recommended with moderate-to-severe (rivaroxaban and endoxaban) or severe (apixaban) liver dysfunction (Child-Pugh class B/C and class C)	High	Lack of ample experience and publications in patients with cancer; concerns for use in patients with gastrointestinal (and genitourinary) tract lesions

egFR, estimated glomerular filtration rate; INR, international normalized ratio.