Table 6. Transition between heparin, warfarin and novel anticoagulants per the FDA.

Agent	Transition (Tr) from Warfarin	Tr to Warfarin	Transition from Anticoagulants (Ac) other than Warfarin	Tr to Ac other than Warfarin
Rivaroxaban	Start when INR is below 3.0	no guidelines; may start parenteral Ac + warfarin at the time of next dose of rivaroxaban	-stop iv heparin and start rivaroxaban at the same time -start 0-2 hours prior to the evening dose of other Ac and skip the other Ac	Ac to be given at the time rivaroxaban would be due and skip rivaroxaban
Dabigatran	Start when INR is below 2.0	• For CrCl ≥50 mL/min, start warfarin 3 days before discontinuing dabigatran • For CrCl 30- 50 mL/min, start warfarin 2 days before discontinuing • For CrCl 15-30 mL/min, start warfarin 1 day before discontinuing • For CrCl <15 mL/min, no recommendations can be made	-stop iv heparin and start rivaroxaban at the same time -start 0-2 hours prior to the evening dose of other Ac and skip the other Ac	wait 12 hours (CrCl ≥30 mL/min) or 24 hours (CrCl <30 mL/min) after the last dose of dabigatran before initiating treatment with a parenteral anticoagulant
Apixaban	Start when INR is below 2.0	may start parenteral Ac + warfarin at the time of next dose of apixaban	Discontinue Ac and begin apixaban at the next scheduled dose	Discontinue apixaban and begin the other Ac at the next scheduled dose

Tr = Transition; Ac = Anticoagulant; iv = Intravenous; CrCl = Creatinine clearance.