Conversion to and from dabigatran to other anticoagulants

Conversion to and from dabigatran to other anticoagulants

Conversion to and from dabigatran to other anticoagulants depends on the period of activity of the drug currently being used.

Conversion from a parenteral anticoagulant to dabigatran

Initiate the dabigatran two hours or more prior to the time of the next scheduled dose of the parenteral anticoagulant like heparin or low molecular weight heparin. If it is from an infusion of heparin that you are trying to convert, initiate the drug at the time of discontinuation of heparin infusion.

Conversion from dabigatran to parenteral anticoagulant

If the creatinine clearance is thirty milliliters per minute or more, wait twelve hours after the last dose of dabigatran for initiating parenteral anticoagulant. When dabigatran is used for thromboprophylaxis after orthopedic surgery, it can be started 24 hours after the last dose of dabigatran, instead of the 12 hours when it is for prevention of embolism in atrial fibrillation [1]. If the creatinine clearance is less than thirty milliliters per minute, you have to wait for one day instead of the usual 12 hours.

Conversion from warfarin to dabigatran

Discontinue warfarin and initiate dabigatran when INR (international normalized ratio of prothrombin time) is less than 2.

Conversion to warfarin from dabigatran

When to start warfarin while discontinuing dabigatran is depending on the creatinine clearance. If the creatinine clearance is more than fifty milliliters per minute, warfarin can be started three days before discontinuation of the drug. If it is between thirty one and fifty milliliters per minute, warfarin is initiated two days before discontinuation of the drug. When the creatinine clearance is between fifteen milliliters per minute and thirty milliliters per minute, initiate warfarin one day prior to discontinuation of the drug [2]. Please note that the effect warfarin on the INR will be better reflected after dabigatran has been discontinued for two or more days.

References

1. Massicotte A. A practice tool for the new oral anticoagulants. Can Pharm J (Ott). 2014 Jan;147(1):25-32.
2. Schulman S, Crowther MA. How I treat with anticoagulants in 2012: new and old anticoagulants, and when and how to switch. Blood. 2012 Mar 29;119(13):3016-23.