From the Guidelines
To transition a patient from Eliquis (apixaban) to Dabigatran, discontinue Eliquis and start Dabigatran when the next dose of Eliquis would have been due, considering the patient's renal function and the specific dosing recommendations for Dabigatran. When transitioning, it's crucial to consider the half-lives of both medications and the patient's renal function. Apixaban has a half-life of 7-8 hours 1, and Dabigatran has a half-life of 14-17 hours 1. For patients with normal renal function, this means stopping Eliquis and starting Dabigatran approximately 12 hours later, as Eliquis is typically dosed twice daily. The standard Dabigatran dosing is 150 mg twice daily for most patients, or 110 mg twice daily for those with higher bleeding risk (such as elderly patients ≥80 years or those taking certain interacting medications) 1. For patients with reduced renal function (CrCl 30-50 mL/min), consider the lower Dabigatran dose, as the half-life of Dabigatran is prolonged in patients with moderate renal impairment 1. Some key points to consider during the transition include:
- No bridging with other anticoagulants is required during this transition, as both medications are direct oral anticoagulants (DOACs) with relatively short half-lives 1.
- It's essential to ensure the patient understands the new medication schedule and potential side effects.
- Dabigatran must be stored in its original packaging to maintain stability, and patients should be advised that it cannot be placed in pill organizers.
- Monitor the patient after transition for any signs of bleeding or thrombotic events, as the risk of these complications may vary during the transition period 1.
From the Research
Transitioning from Eliquis to Dabigatran
There are no specific studies that provide guidance on transitioning a patient from Eliquis (apixaban) to Dabigatran. However, the following points can be considered:
- The pharmacokinetics of anticoagulants, including dabigatran, in patients with renal impairment are discussed in a narrative review 2.
- The management of bleeding in patients taking dabigatran, rivaroxaban, or apixaban is discussed in a study, which notes that there is no routine coagulation test suitable for monitoring these patients and no antidote for these drugs 3.
- The risk of bleeding with apixaban in patients with renal impairment is evaluated in a meta-analysis, which found that the risk of bleeding with apixaban is lower in patients with mild renal impairment compared to conventional anticoagulants 4.
- The safety and effectiveness of apixaban versus warfarin for acute venous thromboembolism in patients with end-stage kidney disease are compared in a national cohort study, which found that apixaban was associated with a lower risk of major bleeding 5.
- The effect of renal impairment on the risk of bleeding and recurrent thrombosis in cancer patients treated with apixaban or dalteparin is evaluated in a prespecified analysis of the Caravaggio trial, which found that moderate renal impairment was not associated with major bleeding or recurrent VTE 6.
Key Considerations
- When transitioning a patient from Eliquis to Dabigatran, it is essential to consider the patient's renal function, as both drugs are affected by renal impairment.
- The risk of bleeding and recurrent thrombosis should be carefully evaluated, taking into account the patient's individual characteristics and medical history.
- Close monitoring of the patient's condition and adjustment of the anticoagulation regimen as needed are crucial to ensure safe and effective treatment. Some key points to consider when transitioning include:
- Dabigatran has a higher risk of bleeding in patients with renal impairment, especially those with severe renal impairment.
- Apixaban has a lower risk of bleeding in patients with mild renal impairment compared to conventional anticoagulants.
- The safety profile of apixaban is confirmed in patients with moderate renal failure, with the potential for improved efficacy in comparison to dalteparin.