Please select the option that best describes you:
Topics:
General Internal Medicine • Rheumatology • Thrombosis • Hematology • Antiphospholipid Syndrome • Benign Hematology • Hemostasis/Thrombosis • Neurology • Pulmonology • Cardiology • Vascular Neurology • Pulmonary Vascular Disease
Would you consider using DOACs as a bridge to warfarin instead of heparin or LMWH?
For example, would you consider this method in an ESRD/HD patient with antiphospholipid syndrome who had a major bleed requiring reversal of warfarin that then needs to be bridged back to warfarin after bleeding is stabilized?
Answer from: at Community Practice
I would feel very comfortable bridging with apixaban, given its relatively short half-life and fairly quick absorption. I think it is very similar to bridging with Lovenox.
More importantly, it usually takes at least 24 hours until heparin IV gets to therapeutic levels - it is often too high or too...
Sign in or Register to read more
Answer from: at Academic Institution
This is an interesting question. My bias would be to bridge back to warfarin under cover of IV unfractionated heparin. Each DOAC has a different elimination route with approximate renal elimination as follows: dabigatran: 80%; edoxaban: 50%; rivaroxaban: 33%; apixaban: 25% (Baker et al., PMID 392236...
Answer from: at Community Practice
I think from a stroke prevention standpoint it depends on the etiology. If someone has a mechanical valve or anti-phospholipid antibody syndrome then this approach may not help significantly for prevention- since the trials in these conditions evaluating efficacy of DOACs didn’t help wit...
Answer from: Medical Oncologist at Community Practice
After 3 months of anticoagulation for APSy, the estimated annual risk of VTE recurrence is about 5% max; this converts into ~0.01% risk/day. On the other hand, the serious bleeding risk with bridging is about 1-2%/day in patients with ESRD/HD [even in the setting of mechanical valve, the estimated a...