Gayatri Digambar: Safe Anticoagulation Conversion
Gayatri Digambar, B.Pharm Finalist and Registered Pharmacist, posted on LinkedIn:
”Anticoagulation Conversion
Mastering the Transition: Ensuring Patient Safety in Complex Drug Therapy
As Registered Pharmacists, managing anticoagulation therapy transitions (bridging) is one of our most critical clinical responsibilities. The precision of these conversions directly impacts patient outcomes and minimizes the risk of bleeding or clotting.
Sharing a look at the key protocols for safely converting between different anticoagulants:
Bridging from Heparin/LMWH to Warfarin: This requires a careful overlap period until the INR is consistently in the therapeutic range (>2 for at least 2 days).
Transitioning to DOACs (Dabigatran, Rivaroxaban, Apixaban): Exact timing is crucial. For instance, stop IV heparin immediately and start the DOAC within 0–2 hours of the next scheduled LMWH dose to maintain anticoagulation continuity.
Warfarin Management: When switching from warfarin to a DOAC, the INR must be checked and confirmed to be <2 before initiating the new agent.
This attention to detail is vital for clinical excellence and regulatory compliance.”
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