Suggestions for Conversion To/From Apixaban

CONVERSION UW MEDICINE RECOMMENDATION
from warfarin to apixaban stop warfarin and start apixaban when INR < lower limit of therapeutic range

from apixaban to warfarin

 

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

 

start warfarin and stop apixaban 3 days later

OR IF continuous, uninterrupted anticoagulation is necessary:

a)  Stop apixaban

b) Begin both a parenteral anticoagulant (LMWH/fondaparinux or UFH) and warfarin at the same time that the next dose of apixaban would have been given

c) Stop the parenteral anticoagulant when INR is > lower limit of therapeutic range

from LMWH/fondaparinux to apixaban stop LMWH/fondaparinux and start apixaban at the same time that the next dose of LMWH/fondaparinux would have been given
from IV heparin to apixaban Stop IV heparin and start apixaban simultaneously
from apixaban to parenteral anticoagulant stop apixaban and administer first dose of parenteral anticoagulant at the time that the next dose of apixaban would have been given
from apixaban to dabigatran, edoxaban, or rivaroxaban stop apixaban and begin the other agent at the time that the next scheduled dose of apixaban would have been given