Starting Pradaxa - Switching to and from Pradaxa

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How do I switch my patients to Pradaxa from warfarin?

To switch to Pradaxa from warfarin, or any other vitamin K antagonist (VKA), treatment with the VKA and start the patient on Pradaxa once their INR falls to <2.0.1

 

An image showing of the progression to Pradaxa (Dabigatran) from VKA

 

 

How do I switch my patients to Pradaxa from a continuous parenteral anticoagulant?

For patients receiving continuous parenteral anticoagulants, such as intravenous unfractionated heparin (IV UFH), simply stop their previous treatment and start Pradaxa immediately.1

An image showing of the progression to Pradaxa (Dabigatran) from IV UFH

How do I switch my patients to Pradaxa from a parental anticoagulant?

When switching a patient to Pradaxa from an injectable anticoagulant, give Pradaxa 0–2 hours prior to the time the next dose of injectable anticoagulant would have been due.1

For your DVT/PE patients, Pradaxa can be easily started following at least 5 days of heparin (LMWH).1 Give Pradaxa 0–2 hours prior to the time at which the dose of LMWH would have been due.1

 

An image showing of the progression to Pradaxa (Dabigatran) from previous injectable anticoagulants

 

Why is renal assessment necessary before initiation of Pradaxa?

Patients with mild to moderate renal impairment can be treated with Pradaxa however, it is contraindicated in those with severe renal impairment
(CrCL <30 mL/min). Renal function should therefore be assessed by calculating the CrCL prior to initiation of treatment with Pradaxa to exclude patients with severe renal impairment.1

While on treatment the patient’s renal function should also be assessed in certain clinical situations where you suspect that their renal function could decline or deteriorate.1

How do I switch my patients from Pradaxa to a parenteral anticoagulant?

For patients being treated for primary prevention of venous thromboembolism (pVTEp), it is recommended to wait 24 hours after the last dose of Pradaxa before switching to a parenteral anticoagulant.1
For patients with non-valvular atrial fibrillation (NVAF) being treated for stroke prevention, it is recommended to wait 12 hours after the last dose of Pradaxa before switching to a parenteral anticoagulant.1

References: 
  1. Pradaxa Summary of Product Characteristics 2016. Boehringer Ingelheim.