Abstract A 59-year-old female with Child-Pugh class B cirrhosis attributed to nonalcoholic steatohepatitis complicated by hepatic encephalopathy, portal hypertension with esophageal varices, and thrombocytopenia is seen for management of an acute segmental right lower lobe pulmonary embolism in a clinic. She is hemodynamically stable. Complete blood count is notable for hemoglobin 11.6 g/dL and platelets 80 K/μL. Prothrombin time is 12.6 seconds; partial thromboplastin time, 33.7 seconds; and fibrinogen, 221 mg/dL. She was referred to discuss if a direct oral anticoagulant (DOAC) can be used for anticoagulation. What would you suggest?