Apixaban (Eliquis): 10 mg twice per day for 7 days, then 5 mg twice per day

From warfarin to apixaban:

Discontinue warfarin and initiate apixaban when INR is < 2.0.

To warfarin from apixaban:

Discontinue apixaban and begin both a parenteral anticoagulant and warfarin when the next dose of apixaban is due; discontinue parenteral anticoagulant when INR reaches the target range.

From oral or parenteral anticoagulants to apixaban:

Discontinue anticoagulant and begin apixaban when the next dose of the anticoagulant is due.

To oral or parenteral anticoagulants from apixaban:

Discontinue apixaban and begin the new anticoagulant when the next dose of apixaban is due.

Dabigatran (Pradaxa): 150 mg twice per day after 5 to 10 days of parenteral anticoagulation

From warfarin to dabigatran:

Discontinue warfarin and initiate dabigatran when INR is < 2.0.

To warfarin from dabigatran based on CrCl:

CrCl > or = 50 mL per minute per 1.73 m² (0.83 mL per second per m²): initiate warfarin 3 days before discontinuation of dabigatran.

CrCl 30 to 50 mL per minute per 1.73 m² (0.50 to 0.83 mL per second per m²): initiate warfarin 2 days before discontinuation of dabigatran.

CrCl 15 to 30 mL per minute per 1.73 m² (0.25 to 0.50 mL per second per m²): initiate warfarin 1 day before discontinuation of dabigatran.

CrCl < 15 mL per minute per 1.73 m²: not recommended.

From a parenteral anticoagulant to dabigatran:

Initiate dabigatran < or = 2 hours before the next dose of the parenteral anticoagulant is due or at the time of discontinuation for a continuously administered parenteral drug; discontinue parenteral anti-coagulant at the time of dabigatran initiation.

To a parenteral anticoagulant from dabigatran:

Wait 12 hours (CrCl = or > 30 mL per minute per 1.73 m²) or 24 hours (CrCl < 30 mL per minute per 1.73 m²) after the last dose of dabigatran before initiating a parenteral anticoagulant.

Edoxaban (Savaysa): 60 mg every 24 hours after 5 to 10 days of initial therapy with a parenteral anticoagulant

From warfarin to edoxaban:

Discontinue warfarin and start edoxaban when the INR is < 2.5.

To warfarin from edoxaban:

For patients taking 60 mg, reduce dose to 30 mg and begin warfarin concomitantly.

For patients taking 30 mg, reduce dose to 15 mg and begin warfarin concomitantly.

INR must be measured at least weekly and just before the daily dose of edoxaban to minimize the influence of edoxaban on INR measurements.

Discontinue edoxaban and continue warfarin once a stable INR of > 2 is achieved.

Parenteral option: Discontinue edoxaban and administer a parenteral anticoagulant and warfarin when the next dose of edoxaban is due; once a stable INR of > 2.0 is achieved, discontinue parenteral anticoagulant and continue warfarin.

From continuous infusion of unfractionated heparin to edoxaban:

Discontinue heparin infusion and initiate edoxaban 4 hours later.

From LMWH to edoxaban:

Discontinue LMWH and initiate edoxaban when the next dose of LMWH is due.

From oral anticoagulants to edoxaban:

Discontinue current oral anticoagulant and initiate edoxaban when the next dose of the initial oral anticoagulant is due.

To a parenteral anticoagulant or oral anticoagulant from edoxaban:

Discontinue edoxaban and start the other oral anti-coagulant when the next dose of edoxaban is due.

Rivaroxaban (Xarelto): 15 mg twice per day for 21 days, 20 mg once per day (should be taken with food)

From warfarin to rivaroxaban:

Discontinue warfarin and initiate rivaroxaban as soon as the INR decreases to < 3.0.

To warfarin from rivaroxaban:

Discontinue rivaroxaban and initiate warfarin and a parenteral anticoagulant when the next dose of rivaroxaban is due.

From continuous infusion of unfractionated heparin to rivaroxaban:

Initiate rivaroxaban at the time of heparin discontinuation.

From anticoagulants (other than continuous infusion of unfractionated heparin) to rivaroxaban:

Discontinue current anticoagulant and initiate rivaroxaban < or = 2 hours before the next evening dose of the discontinued anticoagulant is due.

To other anticoagulants (other than warfarin) from rivaroxaban:

Discontinue rivaroxaban and initiate the anticoagulant when the next dose of rivaroxaban is due.