A literature search was carried out to identify studies that compared rivaroxaban and low-molecular-weight heparin (LMWH) to prevent and treat venous thromboembolism (VTE). The literature research was constructed to identify studies whose results evaluate efficacy, safety and economic outcomes. The following were conducted:

Keywords: Keywords and MeSH terms used in literature search were: rivaroxaban, low-molecular-weight heparin, venous thromboembolism, VTE prevention, cost-effectiveness, major bleeding, and cancer-related thrombosis.

Search Limitation: The inclusion was restricted to English-language and peer-reviewed journals. The search criteria were works published after 2010 to get an update of information and data on the anticoagulation therapy.

The following electronic databases were searched for the studies: PubMed and Web of Science. These databases were chosen to comprehensively cover clinical trials, observational studies, and economic analyses from various disciplines.

To be included in this review, studies had to meet the following criteria: Population: Adult (≥18 years) patients with diagnosed venous thromboembolism (VTE) or at high risk for VTE (cancer patients and orthopedic surgical patients). Intervention: Rivaroxaban use compared with LMWH for VTE prevention or treatment. Outcomes: Reporting primary outcomes of VTE recurrence, major bleeding, all-cause mortality, and cost-effectiveness (QALY or total healthcare expenditure). Study Design: Randomized controlled trials (RCTs), cohort studies, case-control studies, and economic analyses.

Exclusion criteria were: Non-peer-reviewed articles, case reports, or editorials. Studies in pediatric populations (<18 years). Studies with sparse data on comparing rivaroxaban and LMWH.

Data from the eligible studies were extracted independently by two reviewers to ensure consistency. The following data were extracted: Study design. Patient characteristics (age, sex, comorbidities). Type of VTE (DVT, PE). Intervention details (dosage, duration of treatment). Outcomes: VTE recurrence, major bleeding, mortality, and economic consequences. Disagreements were resolved by consensus or consulting a third reviewer.

For transparency and methodological rigor, a PRISMA flow diagram was created to display the study selection process (Figure 1). The diagram shows the number of records identified, screened, eligible studies, and those ultimately included in the review.

Although every effort was made to identify all studies relevant to this, the following limitations exist:Heterogeneity of populations, interventions, and outcome reporting studies. Real-world evidence included in the review has the possibility of introducing bias by patient selection and lack of randomization. Publication bias may have influenced the results, as studies with negative or null results are less likely to be published.

This systematic review provides a comprehensive synthesis of the evidence comparing rivaroxaban and LMWH for the management of VTE. It will include high-quality studies, such as those derived from the EINSTEIN and SEER-Medicare databases, allowing for the possibility of making definitive conclusions regarding efficacy, safety, and cost-effectiveness. The PRISMA flow diagram and data extraction procedures ensure transparency, and the results will guide clinicians and policymakers in their decision-making.

Rivaroxaban is a direct oral anticoagulant (DOAC) that directly inhibits a key factor in the coagulation cascade, Factor Xa, which converts prothrombin to thrombin. Rivaroxaban inhibits thrombin generation and clot formation of fibrin as it blocks this crucial process (Hindley et al., 2023). Compared to the vitamin K antagonists like warfarin, which inhibit various clotting factors nonselectively, Rivaroxaban consistently produces an anticoagulant response.

The selectivity of this drug has been described based on a good safety profile when administered clinically. Clinical studies have shown that Rivaroxaban is effective compared to LMWH, which has a lower risk of developing an acceptable bleeding rate. Its high oral bioavailability gives it a higher plasma level with better convenience and compliance over injectable courses (Wu et al., 2024a). In addition to anticoagulation, Rivaroxaban has also been investigated to have potential anti-inflammatory effects with the prospect of seeing application in the use of Rivaroxaban in the treatment of cancer-related thrombosis, where inflammation is a primary pathognomonic driver (Coleman et al., 2022). The last properties can be another therapeutic benefit in multifactorial clinical conditions of multifactorial etiopathogenesis, when thrombogenesis is present.

Enoxaparin and dalteparin are low-molecular-weight heparins prepared by fractionating unfractionated heparin by enzymatic or chemical means. Regarding unfractionated heparin, LMWHs have more predictable pharmacokinetics, decreased monitoring necessities, and are less likely to cause heparin-induced thrombocytopenia (Nair et al., 2020).

The mechanism behind the anticoagulant action of LMWHs has been observed because of binding to antithrombin III, increasing inhibition of Factor Xa extent, thrombin (lesser extentactor Factor IIa). Their Factor Xa selectivity differs among preparations. Enoxaparin (nominal mean molecular weight ranges of 3,800–5,000 Da) and dalteparin (ranges 5,000–6,000 Da) have ratios of anti-Xa/anti-IIa activity of 3.3–4.1:1 and 2.0–2.8:1, respectively (Merli et al., 2016). The increased anti-Xa specificity has been linked to successful prophylaxis and a marginally lower chance of bleeding complications.

In a systematic review and analysis of 25 random trials, LMWH was found to lower the chances of major bleeding by 36% as compared to unfractionated heparin (RR = 0.64, 95% CI: 0.44–0.93, p = 0.02) (Bochenek and Nizankowski, 2012). However, renal clearance is a significant limitation. LMWHs get accumulated in renal-impaired patients and need dose adjustment as creatinine clearance falls below 30 mL/min. Despite this, LMWHs have less interpatient variability than unfractionated heparin and are generally suitable for extended use in heterogeneous populations (Kohn et al., 2019).

Safety profiles are an essential consideration in the selection of anticoagulants, particularly in high-risk individuals such as cancer patients, the elderly, or renal-impaired patients (Olie et al., 2021). The risk of bleeding and tolerance of both LMWH and rivaroxaban have been vigorously tested.

Some studies have reported a slight increase in minor bleeding with rivaroxaban compared to LMWH, but other studies have contested this. Still, risks are similar in terms of severe bleeding and the risk of all-cause mortality. Costa et al. (2020) and McBane et al. (2016), among others, discovered that rivaroxaban and LMWH had similar efficacy in preventing VTE among cancer patients, with no significant differences in serious bleeding events. These findings warrant the prospect of rivaroxaban being a safe alternative in these patient groups.

LMWH safety is dependent on renal function. Reduction in dosage is needed in patients with a <30 mL/min clearance to prevent drug accumulation. Although LMWHs exhibit a high safety aspect of bleeding in most cases, renal impairment poses a significant risk (Streiff et al., 2019). Rivaroxaban, however, should only be cautiously coadministered with strong CYP3A4 and P-glycoprotein inhibitors as a result of the increased exposure of the drug and the likelihood of bleeding. Figure 2 shows relative bleeding outcomes in cancer-related thrombosis.

Drug–drug interactions further define these agents. Rivaroxaban is a substrate for CYP3A4 and P-glycoprotein. Co-administration with potent inhibitors (e.g., azole antifungals, HIV protease inhibitors) will increase plasma concentrations and risk of bleeding (Wu et al., 2024b). LMWHs undergo hepatic metabolism by depolymerization and desulfation and have fewer clinically significant drug interactions, further adding to their margin of safety in polypharmacy scenarios (van der Sangen et al., 2021). Table 1 compares rivaroxaban and LMWH regarding the most significant aspects to represent the pharmacologic and practical distinctions.

The contrast between rivaroxaban and LMWH emphasizes the evolving landscape of anticoagulation. LMWH is still a safe and effective option, especially in hospitalized patients, or where drug interactions are less probable (You et al., 2025). The convenience of rivaroxaban and potential adherence benefits based on oral administration and predictable pharmacology render it an attractive option for outpatient prophylaxis and extended duration of use. Both drugs are comparable in efficacy and overall similar in safety, but their practical differences highlight the necessity for individualized decision-making (Yoon et al., 2023). In cancer patients, the elderly, and multimorbid patients, evidence suggests that rivaroxaban can be utilized as a substitute for LMWH, provided renal and hepatic function are normal and drug interactions are managed.

In summary, rivaroxaban and LMWH share a comparable foundation of clinical efficacy but differ in pharmacologic properties, safety profiles, and convenience. These differences must be weighed carefully in tailoring therapy to patient-specific needs, forming the following rationale for clinical comparisons in Section 4.

The measures to be considered in assessing the effects of anticoagulant therapy are VTE recurrence, bleeding events, and the mortality related to any cause (Kohn et al., 2019). Several studies concluded that rivaroxaban and LMWH cannot be considered any more efficient in their effects on patients with cancer-related thromboses, as both drugs are efficient in preventing the recurrence of VTE (Wu et al., 2024a). This tradeoff between safety and efficacy is fundamental in cancer patients, as the anticoagulation treatment should mitigate the impact of thrombosis without increasing bleeding complications.

Among 655 cancer patients with VTE (EINSTEIN-DVT and EINSTEIN-PE), rivaroxaban had a non-significant trend toward reduced mortality versus LMWH (16.4% vs. 17.6%; hazard ratio [HR] = 0.93, 95% CI: 0.64–1.35, p = 0.30), suggesting possible benefits in survival, although not statistically significant (Xing et al., 2019). Similarly, a retrospective cohort study of 296 cancer patients with VTE showed a trend toward lower mortality in the rivaroxaban group (8.0% vs. 10.0%, p = 0.602) (Dong et al., 2024). Though these results were insignificant, the consistent trends in studies are interesting and suggest that rivaroxaban may have a potential survival benefit in cancer patients, which needs further exploration. Figure 3 illustrates mortality in this study.

Postoperative hypercoagulability in orthopedic surgery, particularly after total hip arthroplasty, is also prevented importantly by rivaroxaban. A retrospective analysis of 110 patients proved rivaroxaban to be linked with fewer patients showing signs of postoperative day 3, 5, and 7 hypercoagulability (41.67% vs. 72%; 60% vs. 84%; 76.67% vs. 92%; p < 0.05) (Sun et al., 2020). This indicates that rivaroxaban can offer improved thromboprophylaxis, lowering the incidence of VTE and facilitating post-surgery recovery.

Real-world data are essential in determining real-world outcomes of anticoagulants like rivaroxaban in daily clinical practice. In a SEER-Medicare study of patients with cancer and VTE, rivaroxaban was compared with LMWH for recurrent VTE, major Bleeding, and all-cause mortality. The results were that none of the differences in outcome were statistically significant: Recurrent VTE (HR = 0.91, 95% CI: 0.51–1.62), Major Bleeding (HR = 0.90, 95% CI: 0.29–2.83), All-cause mortality (HR = 0.86, 95% CI: 0.62–1.21) (Kohn et al., 2019). These findings confirm the efficacy and safety equivalence of the two drugs in real-world use, suggesting that both rivaroxaban and LMWH possess similar efficacy in preventing recurrent VTE and controlling bleeding risk. Nevertheless, rivaroxaban is preferable because it is orally administered and thus can be used for long-term use, particularly in outpatient settings.

Integrating real-life evidence into clinical decisions is essential to address patient-specific concerns such as comorbidities, drug interactions, and compliance. As highlighted by Beyer-Westendorf et al. (2016), the role of rivaroxaban in individualized anticoagulant therapy can optimize treatment among various categories of patients with a flexible and patient-centered strategy towards preventing VTE.

Relative efficacy of rivaroxaban and LMWH is discussed below in Table 2, which collects significant results from clinical trials and real-world data:

Rivaroxaban is equally effective as LMWH in the prevention and treatment of VTE in most clinical scenarios, including cancer-associated thrombosis and orthopedic surgery. Although there are minor differences in bleeding risks, rivaroxaban’s oral administration is extremely convenient for patients and is non-inferior to LMWH for serious Bleeding and VTE recurrence (Kohn et al., 2019). Real-world experience also substantiates the use of rivaroxaban in daily clinical practice, with the safety and efficacy of rivaroxaban established in diverse populations. With continually more precise data from further research, the place of rivaroxaban in patient-specific, individualized anticoagulation will only grow.

While rivaroxaban and LMWH are effective within the general VTE population, limited data are available on their effectiveness in high-risk subgroups with renal impairment, liver disease, or elderly patients. In more recent years, these gaps have begun to be filled:

Renal Impairment: In a paper by McBane et al. (2016), patients with moderate renal impairment (CrCl 30–50 mL/min) were assessed for rivaroxaban. The results revealed that rivaroxaban was similar to LMWH for preventing recurrent VTE. However, dosing was possibly needed in patients with severe renal impairment (CrCl <30 mL/min) due to increased drug exposure (Nair et al., 2020). LMWH is still preferred in the latter group due to its more linear clearance and ability to monitor anti-Xa levels.

Liver Dysfunction: Liver disease poses a unique challenge for anticoagulation therapy. Rivaroxaban is not recommended in patients with moderate or severe impairment of the liver since drug metabolism is altered and an increased risk of bleeding cannot be excluded. However, in patients with mild liver impairment, rivaroxaban can be given cautiously. However, LMWH is generally preferred due to its consistent pharmacokinetics and good profile in patients with liver impairment (Jones et al., 2024).

Geriatric Populations: Geriatric patients (≥75 years) are at higher risk of adverse effects on bleeding. A subgroup analysis of the EINSTEIN trials showed that rivaroxaban was well tolerated in the geriatric patient group. However, careful monitoring of bleeding symptoms, especially in patients with comorbidities such as hypertension or renal failure, was necessary (Xing et al., 2019). LMWH remains first-line in this age group if renal function is compromised due to the ease with which the dose can be modified and its established safety profile. Further research, primarily randomized controlled trials in such subgroups, is necessary to standardize these populations’ management further.

Correctly identifying high-risk patients guarantees maximum benefit gain in the anticoagulation therapy compared to the side effects of use. Patients at high risk include those with a history of pulmonary or thrombotic disease, cancer, atrial fibrillation, and critically ill patients. Certain conditions and groups of patients have to be assessed critically:

Cancer Patients: Cancer significantly increases the risk of VTE. Cancer-related thrombosis is common, particularly in chemotherapy patients, who need personalized anticoagulation therapy (Rus et al., 2024).

Atrial Fibrillation: Anticoagulation risk stratification in atrial fibrillation is typically done with the CHA2DS2-VASc score to estimate thromboembolic risk, and the HAS-BLED score to assess bleeding risk (Gorog et al., 2022).

Renal Impairment: Renal dysfunction patients have an increased risk of bleeding and of inadequate anticoagulation. Dosage adjustment is necessary to achieve a therapeutic effect without diminished safety.

Older Patients: Elderly patients, especially those over the age of 75 years, are at higher risk of bleeding due to altered pharmacokinetics with age and comorbidities.

By early recognition of such high-risk populations, clinicians can intervene early and appropriately to optimize patient outcomes.

Individualized anticoagulation treatment is successful. Rivaroxaban or LMWH can be chosen depending on several factors, including renal function, comorbid conditions, compliance, and patient preference. These guide the selection of treatment to provide the best for the patient.

Rivaroxaban: Rivaroxaban is a direct Factor Xa inhibitor taken orally with predictable pharmacokinetics, so it is best suited for outpatient settings. Oral intake enhances patient compliance and is specifically helpful in patients who do not like injections. In addition, it does not need regular monitoring and has fewer food interactions, enhancing its long-term treatment use (Tanaka-Esposito and Chung, 2015).

LMWH: Inpatient treatment or, in the event of emergency anticoagulation, is the most frequent use of LMWH, as it acts immediately with a therapeutic effect by subcutaneous injection. LMWH can be conveniently adjusted based on anti-Xa monitoring, which is helpful in renal failure or other special needs (Rus et al., 2024). Surgical patients benefit from the adjustable dose of LMWH and its established efficacy as the first-choice drug in short-term therapy.

Both medications require careful dose modification in patients with renal impairment. For instance, rivaroxaban is contraindicated in patients with severe renal impairment (CrCl <15 mL/min). At the same time, LMWH requires dose adjustment in moderate renal impairment to avoid drug accumulation and bleeding to ensure its efficacy (Sherrard et al., 2016). A tailored treatment considers patient values, lifestyle, and compliance with therapy. Collaborating with patients and families in the decision process for treatment, which is aligned with personal preference, for instance, an oral medication for ease or an injectable drug for improved acute control, will significantly impact the outcome.

Safe anticoagulant therapy relies on the establishment of absolute and relative contraindications. These contraindications must be carefully assessed before initiating treatment to serve as a protective measure for the patient and to prevent harm.

For high-risk populations such as renal insufficiency, liver disease, and the elderly, anticoagulation therapy must be individually tailored not to induce unwanted effects but to maximize effectiveness.

Renal Impairment: Patients with mild to moderate renal impairment can be treated with rivaroxaban with dose reduction and appropriate monitoring, especially in those with a CrCl of 30–50 mL/min. However, LMWH is a better treatment choice in severe renal impairment patients (CrCl <30 mL/min) due to the modifiable dosing and more stable anticoagulant effect, Monitoring anti-Xa factor (Wang et al., 2023).

Hepatic impairment: Rivaroxaban is acceptable for patients with mild hepatic impairment. Nevertheless, LMWH is usually favored because it can be administered on a patient-specific basis regarding renal function and is relatively predictable in its off-site impact. Hepatic moderating to severe impairment is contraindicated for rivaroxaban (Khorana et al., 2017). LMWH is preferable in this kind of patient, particularly in VTE, where the risk of bleeding should not be enhanced.

Older Populations: Older patients are more at risk of having bleeding episodes. In the elderly, rivaroxaban therapy will require close monitoring (based on renal clearance and dose reduction based on weight). The HAS-BLED score can assist in assessing the risk of bleeding (Heisen et al., 2017). In the elderly (75 years and upwards) with increased bleeding risk, LMWH is preferably indicated, especially in cases of issues of medication compliance or when there are also some severe comorbidities.

The advent of oral anticoagulant rivaroxaban has resulted in several papers evaluating its cost-effectiveness with conventional therapy, i.e., LMWH. The issue of treating VTE using anticoagulant medicine has an enormous economic impact, as the burden of this investment alone adds significant value to medical care across the globe (Khorana et al., 2017). The ease of administration of rivaroxaban is due to the solid nature of this medication, which does not require extraordinary storage conditions or intravenous administration. This suffices to decrease the use of medical resources and render rivaroxaban cost-effective in some cases. In one study of patients facing surgery (total hip replacement), rivaroxaban prophylaxis for a total of 35 days was found to be based on SEK 29,400 per QALY. The other option, 14 days of dalteparin sodium and/or enoxaparin use amounts to SEK 35,400/QALY (Heisen et al., 2017). This will mean that, though a higher dose clinically, rivaroxaban may be more economical when considering the long-term effectiveness, since this drug is a tablet and does not need much monitoring.

According to the research conducted by Nielsen et al. (2019) in the US, the sum of all medical costs of the rivaroxaban group was about 1800 dollars lower than that of LMWH. The optimal level of cost savings was achieved in cases of cancer-induced VTE, and savings were observed at an impressive figure of 4,500 dollars per patient compared to LMWH therapy with rivaroxaban (Khorana et al., 2017). These results demonstrate the economic advantage of rivaroxaban in patients with cancerous thrombosis, since such patients require a prolonged anticoagulant establishment. The redemption cost of rivaroxaban as a drug to treat pulmonary embolism in cases of emergencies was overwhelming. The patients taking rivaroxaban were also admitted and spent a reduced time in the emergency unit, resulting in 2150-dollar $2,150 savings in the LMWH-Warfarin combination (Bookhart et al., 2013). Patel et al. (2015) have found that decreased monitoring needs of rivaroxaban are less expensive, and the average total cost-saving per patient was 3,400 dollars due to the decrease in consumption of healthcare resources (Figure 4).

Rivaroxaban use in oral delivery is highly disruptive to the hospital workflow due to transferring VTE care to the outpatient setting. This is in contrast with subcutaneous therapy with LMWH, which complicates the logistics of administering anticoagulants due to the need to supply staff administration resources to hospitals and is a challenge to manage, seeing that the complex process of administering anticoagulants is through an intracutaneous process (Heisen et al., 2017). The simplicity of the therapy negates the load on health personnel’s resources, allowing them to spare time on other important activities. In addition, rivaroxaban is pharmacokinetically stable, and there is no food effect, decreasing the number of routine coagulation tests typically required with LMWH (Bookhart et al., 2013). This eliminates the pressures of laboratory space and requires time and cost savings on repeat testing. Second, there is a decreased requirement for repeat visits with oral dosing, hence there is also a minimised traffic on outpatient clinics and consequent emergency and outpatient expenditure. This statement was confirmed in a study conducted by Merli et al. (2016) on the spending pattern of rivaroxaban and LMWH-Warfarin patients; rivaroxaban patients had 48% lower spending on emergencies and 50% lower spending on outpatients, and an overall average saving of $289 per patient per month. Such savings could be game-changing in the healthcare environment where VTE costs are minimized, particularly in low-income hospitals.

The long-term assessments of rivaroxaban still sustain the fact that the drug is cost-effective, particularly with fewer readmissions and fewer complications. A conceptual commercial health plan using rivaroxaban forecasted a 5 percent cut in inpatient days, which can indicate complication reduction of VTE treatment. It resulted in substantial savings (Patel et al., 2015). The central aspect that makes rivaroxaban very cost-effective in the long term is its dependable clinical outcomes and higher levels of patient compliance. Enhanced adherence to anticoagulation care also increases typical health outcomes, including diminished VTE recurrence and sequelae, further minimizing medical costs (Smith et al., 2018). Besides, compliance has been found to prevent readmission, resulting in a reduced length of stay and a reduction of the overall expenditure of healthcare costs (Bookhart et al., 2013). These long-term returns indicate that even though rivaroxaban is more expensive upfront, it can potentially reduce the overall healthcare expenditure due to its practical benefits of long-term management and patient outcomes.

The future has to be defined by continuous innovations, particularly regarding the potential for improved efficacy, enhanced safety, and minimized side effects. Among the most interesting tendencies, the enhanced use of the DOACs, including rivaroxaban, exposes consequences immeasurably greater compared to the usual treatment presented in warfarin (Lo et al., 2022). The oral administration of DOACs has reliable pharmacokinetics and low dietary requirements, and they do not require frequent coagulation monitoring. These drugs are revolutionizing the course of treatment of the conditions of atrial and VTE fibrillation and long-term treatment regimens (Yamashita et al., 2022). Individualized anticoagulation care in accordance with genetic susceptibility and burden of disease is among the breakthroughs in the sector. The pharmacogenetic field helps every individual make the wisest selection of anticoagulant medication. New studies focusing on the genetic variation of cytochrome P450 enzymes, which increase or decrease the efficacy of DOACs, have been in development (Kotalczyk et al., 2021). Abelacimab is a fully human monoclonal antibody. In a Phase II clinical trial assessing VTE prevention after total knee arthroplasty, the 75 mg abelacimab group (5%; 95% CI: −26.0 to −7.6, p < 0.001) and the 150 mg group (4%; 95% CI: −26.7 to −8.8, p < 0.001) demonstrated significantly superior efficacy compared to enoxaparin (22%) (Verhamme P et al., 2021). This indicates that postoperative inhibition of factor XI is an effective and safe anticoagulation strategy that has the potential to achieve the goal of ‘antithrombosis without causing bleeding’.

The other area where rapid advancements are being achieved is in the preparation of reversal agents for the DOACs, e.g., for rivaroxaban. The change in the effect of DOACs is significant; such factors include reversal agents, such as asexanet alfa (Factor Xa agents) and idarucizumab (Dabigatran) (Milling et al., 2023). This is required in the acute setting, where it is in the interest of antidoting against anticoagulation and expediently accomplishing this. This will make the agents more available and affordable, thus widening the antithrombotic safety balance of DOACs and, accordingly, increasing their applicability in the real clinical environment (Smith et al., 2018).

Despite these advances, there are still gaps in the knowledge related to research on anticoagulation treatment. Findings regarding the safety and efficacy of DOACs in patients with end-stage renal and liver failure, pregnant women, and those with a history of active cancer are of utmost interest in future studies (Kotalczyk et al., 2021). Guidance documents are pieces of general advice, but in high-risk populations, clinical trial information is poor (Wang et al., 2023). Moreover, cross-reaction of other drugs, especially with anticoagulants and in combination therapy (dual/triple therapy; patients taking antiplatelet and anticoagulants), needs additional studies (Erkan et al., 2014). The interactions of DOACs with coadministered drugs among patients with acute coronary syndrome or undergoing percutaneous coronary intervention will be simplified to optimize the regimen and to minimize bleeding (Lo et al., 2022).

Finally, research into resistance and failure of DOAC, potentially caused by drug-drug interaction, drug absorption issues, or non-compliance, is critical. Such research will ensure that patients receive the optimum and safest treatment, reducing repeated occurrences of VTE despite proper anticoagulation (Jones et al., 2024).

With the increasing advancements in the field of medicine, clinical guidelines have to be updated with the latest evidence, especially pharmacogenomic information and novel treatment modalities. Clinical practitioners must be educated on the nuances of anticoagulant selection and patient-specific factors, thereby improving the care of patients. Implementing decision-support tools within electronic health records will also enable clinicians to adhere better to guidelines and make informed, patient-centered decisions (Butler et al., 2022). Also, closing gaps in access to anticoagulant therapy will give all patients equal treatment regardless of socioeconomic status.