Official info from Coagulation Unit Staff AND a professional Haematologist they contacted at 4pm just before a long bank holiday weekend where I would have been entirely isolated and without help or guidance.
Unofficial info taken from Google AI
Can a patient be directed to stop Warfarin treatment one day, (without any kind of INR monitoring process) and immediately start RIVAROXABAN the next?
AI Overview
Yes, a patient can be directed to stop Warfarin one day and start Rivaroxaban the next, but standard clinical guidelines require an INR check first to ensure the blood is not already too thin (over-anticoagulated).
While it is possible to switch immediately, it is generally done based on an International Normalized Ratio (INR) result, not blindly.
The Standard Switch Protocol
According to clinical guidelines (e.g., NICE CKS, NHS, EHRA), the transition from warfarin to rivaroxaban follows specific rules to avoid bleeding or under-anticoagulation:
- For Atrial Fibrillation: Stop warfarin and start rivaroxaban when the INR is 3.0 or lower.
- For DVT/PE Treatment: Stop warfarin and start rivaroxaban when the INR is 2.5 or lower.
What if no INR is Checked?
The risk of starting a new anticoagulant without knowing the current INR is that if the warfarin has not yet worn off (e.g., if INR is 4.0), starting rivaroxaban immediately could lead to excessive, dangerous anticoagulation and serious bleeding.
However, a pragmatic approach used in specific scenarios (such as when labs are unavailable) is to stop warfarin for 3 days, then start rivaroxaban, as the INR will usually have dropped below 3.0 by then.
Summary of Safety
- Do not switch without consulting a doctor, as the timing depends on your specific INR.
- While an immediate switch (within 24 hours) is possible, it is safe only if the INR is within the permitted range (≤3.0 or ≤2.5, depending on the indication).
- Rivaroxaban works much faster than warfarin; it will be effective immediately, whereas warfarin takes several days to clear your system.
Disclaimer: This information is for educational purposes only. Always follow the specific instructions of your anticoagulation clinic or prescribing physician.
Unofficial info taken from Google AI
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