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Should the decision be made to switch a patient from a VKA to a NOAC, the relevant target INR should be achieved prior to switching.1

According to the individual SmPCs, warfarin or other VKA therapy should be discontinued and NOACs started when:2–5

  • INR <2.0 – Start ELIQUIS2 or dabigatran4
  • INR ≤2.5 – Start edoxaban5
  • INR ≤3.0 – Start rivaroxaban3

When converting patients from VKAs to rivaroxaban, INR values will be falsely elevated after the intake of rivaroxaban. The INR is not valid to measure the anticoagulant activity of rivaroxaban, and therefore should not be used.3

Any prescribing decision should only be made by the prescribing healthcare professional on the basis of sound clinical reasons and after appropriate assessment with patient involvement in the decision making.

Click here to view ELIQUIS (apixaban) prescribing and adverse event reporting information.

Abbreviations

INR = International Normalised Ratio NICE = National Institute for Health and Care Excellence NOAC = Non-VKA Oral Anticoagulant TTR = Time in Therapeutic Range VKA = Vitamin K Antagonist

References
  1. Guimarães PO et al. Int J Gen Med 2015;8:283–291.
  2. Apixaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/2878/smpc.. Accessed August 2019.
  3. Rivaroxaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/2793/smpc.. Accessed August 2019.
  4. Dabigatran Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/4703/smpc.. Accessed August 2019.
  5. Edoxaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/6906/smpc. Accessed August 2019.

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Job code: 432UK1900440-01
Date of preparation: September 2019

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