Can I Switch From Warfarin (Coumadin) to Xarelto?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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The newer anticoagulants like Xarelto (rivaroxaban), known as Factor Xa inhibitors, save you from repeated blood tests for INR checks that you will need while on Coumadin (warfarin). Many folks wonder how they can change from Coumadin to the newer medications.

First, who can use Xarelto? Xarelto is a pill approved for use in folks with a known clot in their leg (deep venous thrombosis or DVT), a clot in their lung (pulmonary embolism or PE), prevention of clot/stroke in people with atrial fibrillation who do NOT have valve disease, and to decrease the risk of forming a clot in your leg or lung after hip or knee replacement surgery.

So how can you transition to newer anticoagulants (Xarelto, Eliquis, or Pradaxa) from warfarin? Only switching warfarin to Xarelto has been specifically studied and the recommendation is that rivaroxaban be started only when the INR is < 3.0 and you’ve stopped your warfarin. There have been no studies that have evaluated the optimal method of switching patients from warfarin to either Eliquis or Pradaxa. Until we have done these studies the current recommendations are as follows: dabigatran (Pradaxa) or apixaban (Eliquis) may be started after you discontinue your warfarin AND your INR is < 2.0.

Dr O.

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