Transitioning Between Anticoagulants

Abstract

There has been rapid growth in the development of anticoagulant drugs. Unfortunately, an “ideal” anticoagulant—one that is rapid-acting and fully reversible, does not require monitoring, and can be used in patients with end-stage renal disease and moderate-severe liver dysfunction—is not available to date. Currently, the differences in the pharmacokinetic and pharmacodynamic properties of each agent allow for a unique, individualized anticoagulation plan for different patients with different underlying indications for anticoagulation therapy. Because of the multiple options for both parenteral and oral anticoagulation available, transitioning between anticoagulants is becoming increasingly common both in the inpatient and outpatient settings. Given the absence of prospective randomized data comparing different strategies for transition between anticoagulants, suggested strategies are largely extrapolated from pharmacokinetic data, as well as from expert opinions. Despite limited data, better understanding on how to safely implement a transition from one anticoagulant drug to another is of utmost importance to minimize the risk of recurrent thromboembolic events and hemorrhagic complications during such periods of transition between different drugs.