Why does edoxaban need bridging?

The purpose of this bridging approach was to reduce the risk of thrombotic complications during anticoagulant transition, as observed with rivaroxaban in the ROCKET-AF trial [33].

Do you need to bridge with apixaban?

This means that apixaban can be ceased for a shorter period of time than warfarin before invasive procedures, without the routine need to bridge with alternative anticoagulants such as heparin.

Can you bridge with a DOAC?

Unlike warfarin, the DOAC medications have a much shorter time-to-onset and half-life, negating the need for any overlapping or “bridging” anticoagulation.

Does edoxaban require bridging?

Because direct oral anticoagulants such as dabigatran, apixaban, rivaroxaban, and edoxaban provide their effects immediately they do not require bridging with unfractionated or low molecular weight heparin when starting therapy.

What does bridging anticoagulation mean?

‘Bridging” is a term that refers to the use of short-acting anticoagulants (heparin or LMWH) for a period of time during interruption of warfarin therapy when the INR is not within a therapeutic range.

What should I monitor with apixaban?

Although treatment with apixaban at the recommended dose does not require routine laboratory monitoring, measurement of drug level by a chromogenic anti-FXa assay may be useful in exceptional situations where knowledge of the apixaban level may help to inform clinical decisions, e.g. overdose or emergency surgery [5].

Can you bridge warfarin with DOAC?

Despite a consistent pharmacokinetic (PK) profile and rapid onset of action DOACs are not recommended to be utilized peri-procedurally as a bridge for warfarin in clinical guidelines.

When should edoxaban be stopped before surgery?

Minor surgery/procedure: Stop edoxaban 1 day before surgery/procedure (i.e. skip 1 dose), which corresponds to approximately 2-3 half-lives elapsed between stopping apixaban and surgery. surgery (i.e. skip 2 doses), which corresponds to approximately 4-5 half-lives elapsed between stopping edoxaban and surgery.