SWITCHING TO AND FROM VARIOUS ANTICOAGULANTS: A MANAGEMENT STRATEGY FOR CLINICIANS
DOI:
https://doi.org/10.69598/tbps.14.1.95-110Keywords:
switching/transitioning of anticoagulants, parenteral anticoagulants, oral anticoagulantsAbstract
Anticoagulant therapy has long been the gold standard therapy for stroke and/or systemic embolic prevention and treatment. Anticoagulants generally include parenteral anticoagulants that are extensively used in acute situations for an immediate anticoagulant effect, and oral anticoagulants which are used for long-term therapy. Warfarin has been one of the only oral anticoagulants available during in the past 60 years. In recent years, a new generation of oral anticoagulants has been introduced which is challenging thromboembolic prevention and treatment. Switching to and from various anticoagulants are common situations in clinical practices. Individual’s thromboembolic and bleeding risk assessment should be assessed before switching. Moreover, the pharmacokinetic profile of each anticoagulant is also important to guide the best way for anticoagulant switching. For example, patients with a high thromboembolic risk or patients who switch to warfarin that have a slow onset should be given a parenteral anticoagulant for bridging therapy to prevent thromboembolic events. However, the initial bolus of heparin may be omitted for transitioning to heparin infusion in patients with a high bleeding risk.
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