Suggestions for Conversion To/From Rivaroxaban

CONVERSION UW MEDICINE RECOMMENDATION
From warfarin to rivaroxaban

Stop warfarin and start rivaroxaban when INR < lower limit of therapeutic range

(manufacturer recommends stop warfarin and start rivaroxaban when INR < 3)

From rivaroxaban to warfarin

 

(NOTE: rivaroxaban is not intended to be used as a short term "bridge" to warfarin.  These recommendations refer to transitioning patients who are taking rivaroxaban on a long term basis and are switching to warfarin instead)

Start warfarin and stop rivaroxaban 3 days later

OR IF continuous, uninterruped anticoagulation is necessary:

a) stop rivaroxaban

b) begin both parenteral anticoagulation (LMWH or UFH) and warfarin at the time the next dose of rivaroxaban would have been given

c) stop the parenteral anticoagulant when INR reaches an acceptable range

From LMWH/ fondaparinux to rivaroxaban

Stop parenteral anticoagulant and administer rivaroxaban 0-2 hours before the next dose of parenteral drug  would have been given

From IV heparin to rivaroxaban Administer first dose of rivaroxaban at the same time as discontinuation of IV heparin infusion
from rivaroxaban to parenteral anticoagulant Stop rivaroxaban and administer first dose of parenteral anticoagulant at the time the next dose of rivaroxaban would have been given
From rivaroxaban to apixaban, dabigatran or edoxaban

stop rivaroxaban and begin the other agentat the time that the next scheduled dose of rivaroxaban would have been given