Throughout my pharmacy career, a common question I have received from prescribers is around anticoagulation. Whether it is bridging pre op, switching due to patient preference, to avoid multiple labs with warfarin monitoring, or maybe the patient cannot keep his or her vitamin K-rich food intake consistent or due to adverse drug reactions. With DOACs becoming first choice for both patient and physicians here is a quick brain storm of my thinking when posed with this query.
The biggest thing to keep in mind is the basic pharmacokinetic and pharmacodynamics of the medicine i.e. How long 1 dose of the anticoagulant lasts. For this it is also wise to know the patient's renal function in the anticoagulants that are renally adjusted, as well as which anticoagulants affect INR or can affect INR.
Here is a brief summary, for more information head to each SPC referenced below. Also look out for local guidance.
Rivaroxaban
33% renally cleared
t½ ~ 6 to 11 hours
Apixaban.
27% renally cleared
t½ ~ 12 hours.
Dabagitran
85% renally cleared
t½ ~ 12-14 hours
Edoxaban
50% is renally cleared
The t½ 10 - 14 hours.
References:
Rivaroxaban - https://www.medicines.org.uk/emc/product/2793/smpc - accessed on 06/06/19 Apixaban.- https://www.medicines.org.uk/emc/product/2878/smpc - accessed on 06/06/19
Dabigatran - https://www.medicines.org.uk/emc/product/4703/smpc -accessed on 06/06/19
Edoxaban - https://www.medicines.org.uk/emc/product/6905/smpc - accessed on 06/06/19
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