From the Guidelines
To transition from argatroban to Xarelto (rivaroxaban), discontinue the argatroban infusion and immediately administer the first dose of Xarelto, typically starting at 15 mg twice daily with food for 21 days, followed by 20 mg once daily for continued treatment, while monitoring the patient closely for signs of bleeding or thrombosis. When transitioning from argatroban to Xarelto, it's essential to consider the patient's renal function, as Xarelto dosing may vary based on creatinine clearance. For patients with creatinine clearance 15-50 mL/min, a reduced dose of 15 mg once daily may be appropriate for long-term therapy 1.
- Argatroban has a short half-life of less than one hour, allowing for immediate transition to Xarelto without the need for a washout period 1.
- Xarelto directly inhibits Factor Xa, while argatroban is a direct thrombin inhibitor, but both effectively prevent clot formation.
- The patient should be closely monitored during this transition for any signs of bleeding or thrombosis, and should understand the importance of taking Xarelto with food to maximize absorption.
- It's also crucial to note that Xarelto should be taken with food to ensure optimal absorption, and the patient should be educated on the importance of adherence to the prescribed dosing regimen. Key considerations in this transition include:
- Patient's renal function and potential need for dose adjustment
- Close monitoring for signs of bleeding or thrombosis
- Importance of taking Xarelto with food to maximize absorption
- Patient education on adherence to the prescribed dosing regimen.
From the FDA Drug Label
Switching from Anticoagulants other than Warfarin to XARELTO - For adult and pediatric patients currently receiving an anticoagulant other than warfarin, start XARELTO 0 to 2 hours prior to the next scheduled administration of the drug (e.g., low molecular weight heparin or non-warfarin oral anticoagulant) and omit administration of the other anticoagulant. The answer to transitioning from argatroban (an anticoagulant other than warfarin) to Xarelto (rivaroxaban) is to start XARELTO 0 to 2 hours prior to the next scheduled administration of argatroban and omit administration of argatroban 2.
From the Research
Transitioning from Argatroban to Xarelto (Rivaroxaban)
There are no direct studies on transitioning from argatroban to Xarelto (rivaroxaban) in the provided evidence. However, we can look at the general principles of transitioning from argatroban to other anticoagulants:
- Argatroban is a direct thrombin inhibitor used for prophylaxis or treatment of thrombosis in heparin-induced thrombocytopenia (HIT) and for patients with or at risk of HIT undergoing percutaneous coronary intervention (PCI) 3.
- When transitioning from argatroban to warfarin, it is essential to monitor the International Normalized Ratio (INR) and activated partial thromboplastin time (aPTT) closely, as argatroban can prolong the INR 4, 5.
- The risk of thrombosis exceeds the risk of bleeding in patients with HIT despite an INR > 4 during argatroban and warfarin cotherapy 4.
- Argatroban dosing may need to be adjusted based on renal function, with estimated creatinine clearance (Cl(cr)) significantly predicting the therapeutic dose 6.
- When transitioning from argatroban to warfarin, physicians can achieve acceptably low complication rates in HIT patients without systematically over- or under-dosing warfarin 5.
Key Considerations
- Monitor INR and aPTT closely during the transition period
- Be aware of the potential for elevated INR values during argatroban and warfarin cotherapy
- Adjust argatroban dosing based on renal function, if necessary
- Consider the risk of thrombosis and bleeding during the transition period