to Warfarin

• CrCl>50 mL/min: Start Warfarin 3 days before stopping Dabigatran
• CrCl 30-50: 2 days
• CrCl<15-30: 1 day

to Heparin (CI)

• Stop Dabigatran
• CrCl>30: Start CI Heparin without a bolus in 12 hours
• CrCl< 30: Start CI Heparin without a bolus in 24 hours

to LMWH

• Stop Dabigatran
• CrCl>30: Start LMWH in 12 hours
• CrCl< 30: Start LMWH in 24 hours

to Dabigatran

• N/A

to Apixaban

• Stop Dabigatran
• Start Apixaban at time of next scheduled dose

to Rivaroxaban

• Stop Dabigatran
• Start Rivaroxaban <2 hours before next scheduled dose

to Edoxoban

• Stop Dabigatran
• Start Edoxaban at time of next scheduled dose

*Note: Dabigatran, Rivaroxaban, Edoxaban, and Apixaban affect the INR; measuring the INR during coadministration with warfarin therapy may not be useful for determining an appropriate dose of warfarin. To minimize this effect, check INR at trough level of respective medication