For patients with newly diagnosed VTE on IV heparin planned for transition to DOAC, would you start at the loading or maintenance DOAC dose?
If they have been on IV heparin for 3 days, for example, would you subtract those days from the recommended loading dose time?
Answer from: at Community Practice
Agree with Dr. @Tapson. In the clinical trials that led to rivaroxaban and apixaban approval, many patients had 2 days of injected anticoagulant first to arrive at successful outcomes leading to DOAC approval. I suggest IV heparin until hemodynamically normal (for PE), sq LMWH for a dose or two for ...
Enoxaparin upfront unless there is a bad renal failure, and then start a regular loading schedule for the DOAC.
Unlikely, they’ve been therapeutic the full time they were on heparin, so I would not count/trust those days anyway.
While the packaging guidelines recommend a seven-day loading dose (regardless of prior heparin/enoxaparin), in my experience, many people do a shorter loading duration after being on heparin/enoxaparin. I think the above comments about the heparin often not being therapeutic definitely should factor...