Transitioning From Warfarin to DOAC

Last week, we talked about managing Coumadin based on INR levels and how to adjust dosing. We also touched on when to consider transferring a patient from warfarin to a DOAC like Xarelto or Eliquis. Now let's talk about how to transition. Below is a quick overview to consider while in practice. 

• Goal: maintain stable anticoagulation when transitioning between anticoagulants 
• When transitioning from warfarin to another anticoagulant, it can take several days for resolution of warfarin 
• Discontinue warfarin, monitor the PT/INR, and start the DOAC when the INR is ≤2
• DOAC are typically fixed dosing w/o laboratory monitoring 
• Consider checking kidney function prior to starting creatine <30 may be a contraindication (Recommend using Eliquis rather than Xarelto in CKD patients because you can use it even in ESRD patients on dialysis)
• DOAC options 
• rivaroxaban (Xarelto)- once daily dosing 
• apixaban (Eliquis)- BID dosing 
• edoxaban (Lixiana, Savaysa)- once daily dosing
• Consideration: it can be expensive for patients. Sometimes pharmacy can offer them coupons or check the manufacture website for coupons that may be available. 
• I included more specific information about Eliquis below since that is the one I typically use 

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Allison Sowders, CNP