Table 1

How to switch between different anticoagulants

Switching between agentsHow to switchComments
VKA to NOACOnce the INR is <2When transitioning from oral VKA to new direct oral anticoagulants (NOACs) in patients who cannot achieve consistent INR
IV UFH to NOAC2 hours after stopping UFHWhen going from IV to oral
LMWH to NOACWhen the next dose of LMWH was dueWhen transitioning from LMWH to new direct oral anticoagulant (NOACs)
NOAC to VKAConcomitant treatment until INR=2 to 3If patient cannot tolerate NOAC or does not have access to it
NOAC to UFH or LMWHWhen the next dose of NOAC was dueWhen going from new direct oral anticoagulant (NOACs) to parenteral administration
One NOAC to another NOACWhen the next dose of first NOAC was dueWhen switching between one NOAC to another NOAC
  • INR, international normalized ratio; 95 IV, intravenous; LMWH, low molecular weight heparin; NOAC, novel oral anticoagulant; UFH, unfractionated heparin; VKA, vitamin K antagonist.