Q: How do I switch a patient from a DOAC to warfarin?

Dabigatran: Overlap warfarin with dabigatran for 3 days (normal renal function); 2 days (CrCl 30 to 50 mL/min); or 1 day (CrCl 15 to 30 mL/min); note that dabigatran can contribute to INR elevation or, Overlap warfarin with dabigatran until the INR is therapeutic on warfarin. Apixaban: If continuous anticoagulation is needed, discontinue apixaban and start a parenteral anticoagulant with warfarin; continue the parenteral agent until the INR is therapeutic on warfarin. Note that apixaban can contribute to INR elevation or, Overlap warfarin with apixaban until the INR is therapeutic on warfarin, testing right before the next apixaban dose to minimize the effect of apixaban on INR elevation. Rivaroxaban: Discontinue rivaroxaban and start a parenteral anticoagulant with warfarin; continue the parenteral agent until the INR is therapeutic on warfarin. Note that rivaroxaban can contribute to INR elevation or, Overlap warfarin with rivaroxaban until the INR is therapeutic on warfarin, testing right before the next rivaroxaban dose to minimize the effect of rivaroxaban on INR elevation.

Q: How do I switch a patient from a DOAC to warfarin?

Dabigatran: Overlap warfarin with dabigatran for 3 days (normal renal function); 2 days (CrCl 30 to 50 mL/min); or 1 day (CrCl 15 to 30 mL/min); note that dabigatran can contribute to INR elevation or, Overlap warfarin with dabigatran until the INR is therapeutic on warfarin. Apixaban: If continuous anticoagulation is needed, discontinue apixaban and start a parenteral anticoagulant with warfarin; continue the parenteral agent until the INR is therapeutic on warfarin. Note that apixaban can contribute to INR elevation or, Overlap warfarin with apixaban until the INR is therapeutic on warfarin, testing right before the next apixaban dose to minimize the effect of apixaban on INR elevation. Rivaroxaban: Discontinue rivaroxaban and start a parenteral anticoagulant with warfarin; continue the parenteral agent until the INR is therapeutic on warfarin. Note that rivaroxaban can contribute to INR elevation or, Overlap warfarin with rivaroxaban until the INR is therapeutic on warfarin, testing right before the next rivaroxaban dose to minimize the effect of rivaroxaban on INR elevation.

Question 1

How do I switch a patient from a DOAC to warfarin?

William Aird · Accepted Answer

Dabigatran:
- Overlap warfarin with dabigatran for 3 days (normal renal function); 2 days (CrCl 30 to 50 mL/min); or 1 day (CrCl 15 to 30 mL/min); note that dabigatran can contribute to INR elevation or,
- Overlap warfarin with dabigatran until the INR is therapeutic on warfarin.
Apixaban:
- If continuous anticoagulation is needed, discontinue apixaban and start a parenteral anticoagulant with warfarin; continue the parenteral agent until the INR is therapeutic on warfarin. Note that apixaban can contribute to INR elevation or,
- Overlap warfarin with apixaban until the INR is therapeutic on warfarin, testing right before the next apixaban dose to minimize the effect of apixaban on INR elevation.
Rivaroxaban:
- Discontinue rivaroxaban and start a parenteral anticoagulant with warfarin; continue the parenteral agent until the INR is therapeutic on warfarin. Note that rivaroxaban can contribute to INR elevation or,
- Overlap warfarin with rivaroxaban until the INR is therapeutic on warfarin, testing right before the next rivaroxaban dose to minimize the effect of rivaroxaban on INR elevation.

Question 2

How do I switch a patient from a DOAC to warfarin?

William Aird · Accepted Answer

Dabigatran:
- Overlap warfarin with dabigatran for 3 days (normal renal function); 2 days (CrCl 30 to 50 mL/min); or 1 day (CrCl 15 to 30 mL/min); note that dabigatran can contribute to INR elevation or,
- Overlap warfarin with dabigatran until the INR is therapeutic on warfarin.
Apixaban:
- If continuous anticoagulation is needed, discontinue apixaban and start a parenteral anticoagulant with warfarin; continue the parenteral agent until the INR is therapeutic on warfarin. Note that apixaban can contribute to INR elevation or,
- Overlap warfarin with apixaban until the INR is therapeutic on warfarin, testing right before the next apixaban dose to minimize the effect of apixaban on INR elevation.
Rivaroxaban:
- Discontinue rivaroxaban and start a parenteral anticoagulant with warfarin; continue the parenteral agent until the INR is therapeutic on warfarin. Note that rivaroxaban can contribute to INR elevation or,
- Overlap warfarin with rivaroxaban until the INR is therapeutic on warfarin, testing right before the next rivaroxaban dose to minimize the effect of rivaroxaban on INR elevation.

How do I switch a patient from a DOAC to warfarin?

How do I switch a patient from a DOAC to warfarin?

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