Conversion to and From Dabigatran to Other Anticoagulants

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Description: https://johnsonfrancis.org/pro....fessional/conversion
Discussion on 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.
Initiate dabigatran 2 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.
If the creatinine clearance is 30ml/min or more, wait 12 hours after the last dose of dabigatran for initiating parenteral anticoagulant.
When dabigatran is used for thromboprophylaxis after orthopaedic 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.
If the creatinine clearance is less than 30 ml/min, you have to wait for one day instead of the usual 12 hours.
Discontinue warfarin and initiate dabigatran when INR is less than 2.
When to start warfarin while discontinuing dabigatran is depending on the creatinine clearance. If the creatinine clearance is more than 50 ml/min, warfarin can be started 3 days before discontinuation of the drug.
If it is between 31 and 50 ml/min, warfarin is initiated two days before discontinuation of the drug. When the creatinine clearance is between 15 ml/min and 30 ml/min, initiate warfarin one day prior to discontinuation of the drug.
Please note that the effect warfarin on the INR will be better reflected after dabigatran has been discontinued for two or more days.

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