Shashank Joshi/LinkedIn
Feb 2, 2026, 16:45
Shashank Joshi: Switching Among Oral Anticoagulants
Shashank Joshi, Senior Consultant at Joshi Clinic and President of Indian Academy of Diabetes, shared post on LinkedIn:
“Switching among oral anticoagulants
Switching from a DOAC to warfarin
- Apixaban
If continuous anticoagulation is needed, discontinue apixaban and start a parenteral anticoagulant with warfarin; continue the parenteral agent until the INR is therapeutic on warfarin (PI). Note that apixaban can contribute to INR elevation.
-or-
Overlap warfarin with apixaban until the INR is therapeutic on warfarin, testing right before the next apixaban dose to minimize the effect of apixaban on INR elevation (ASH). - Rivaroxaban
Discontinue rivaroxaban and start a parenteral anticoagulant with warfarin; continue the parenteral agent until the INR is therapeutic on warfarin (PI). Note that rivaroxaban can contribute to INR elevation.
-or-
Overlap warfarin with rivaroxaban until the INR is therapeutic on warfarin, testing right before the next rivaroxaban dose to minimize the effect of rivaroxaban on INR elevation (ASH).
Switching from warfarin to a DOAC
- Rivaroxaban
Stop warfarin, monitor the PT/INR, and start rivaroxaban when the INR is less than 3 (PI). - Apixaban
Stop warfarin, monitor the PT/INR, and start apixaban when the INR is less than 2 (PI).
Switching from one DOAC to a different DOAC
- Any DOAC
Start the second DOAC when the next dose of the first DOAC would have been due; do not overlap.”
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