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XARELTO - Transition from or to Apixaban

Last Updated: 08/22/2024

SUMMARY  

  • For patients currently receiving an anticoagulant other than warfarin, start XARELTO 0 to 2 hours prior to the next scheduled evening administration of the drug (e.g., low molecular weight heparin or non-warfarin oral anticoagulant) and omit administration of the other anticoagulant. For unfractionated heparin (UFH) being administered by continuous infusion, stop the infusion and start XARELTO at the same time.1
  • For patients currently taking XARELTO and transitioning to an anticoagulant with rapid onset, discontinue XARELTO and give the first dose of the other anticoagulant (oral or parenteral) at the time that the next XARELTO dose would have been taken.1
  • No clinical data is available to guide converting patients from apixaban to XARELTO, or from XARELTO to apixaban.
  • Clinicians should use their clinical judgement to weigh benefits vs risks for each patient and refer to product labeling for each product as appropriate.2-5
  • Additional citations are included in the REFERENCES section for your review.2-8

Literature Search

A literature search of MEDLINE®, EMBASE®, BIOSIS Previews®, and DERWENT® (and/or other resources, including internal/external databases), conducted on 05 August 2024, did not identify any relevant citations pertaining to this topic.

 

References

1 XARELTO (rivaroxaban) [Prescribing Information]. Titusville, NJ: Janssen Pharmaceuticals, Inc;https://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/XARELTO-pi.pdf
2 Chen A, Stecker E, A WB. Direct oral anticoagulant use: a practical guide to common clinical challenges. J Am Heart Assoc. 2020;9(13):e017559.  
3 Trang J, Nguyen NH, Huynh S. Guidance for transitioning among anticoagulants. AACN Adv Crit Care. 2019;30(3):209-216.  
4 Raval A, Cigarroa JE, Chung MK, et al. Management of patients on non-vitamin K antagonist oral anticoagulants in the acute care and periprocedural setting: a scientific statement from the American Heart Association. Circulation. 2017;135(10):e604-e633.  
5 Cowell RP. Direct oral anticoagulants: integration into clinical practice. Postgrad Med J. 90(1067):529-539.  
6 Strasser KM, Qasem A, Madhusudhana S. Switching between Oral Anticoagulants. Hosp Pract (1995). 2014;42(3):68-74.  
7 Burnett AE, Mahan CE, Vazquez SR, et al. Guidance for the practical management of the direct oral anticoagulants (DOACs) in VTE treatment. is. 2016;41(1):206-232.  
8 Wilbur J, Shian B. Deep venous thrombosis and pulmonary embolism: current therapy. Am Fam Physician. 2017;95(5):295-302.