CONVERSION (“SWITCHING”) AMONG PARENTERAL ANTICOAGULANTS
CONVERSION ("SWITCHING") AMONG PARENTERAL ANTICOAGULANTS
From IV heparin
To IV Heparin
From heparin SQ Q12h
From IV Bivalirudin
From LMWH SQ Q24H
From LMWH SQ Q12H
From Fondaparinux SQ Q24H
Stop SQ heparin and start IV heparin 4 hours before the next dose of SQ heparin would have been given Stop bivalirudin and start IV heparin at the same time Stop LMWH and start IV heparin 4 hours before the next dose of LMWH would have been given Stop LMWH and start IV heparin 4 hours before the next dose of LMWH would have been given Stop fondaparinux and start IV heparin 4 hours before the next dose of fondaparinux would have been given
To heparin SQ Q12H Stop IV heparin and start SQ heparin at the same time
Stop bivalirudin and start SQ heparin at the same time Stop LMWH and give first dose of SQ heparin at the time the next dose of LMWH would have been given Stop LMWH and give first dose SQ heparin at the time the next dose of LMWH would have been given
Stop fondarinux and give first dose of SQ heparin at the time the next dose of fondaparinux would have been given
To IV Bivalirudin
Stop IV heparin and start IV bivalirudin at the same time Stop SQ heparin and start IV bivalirudin 2 hours before the next dose of SQ heparin would have been given
Stop LMWH and start IV bivalirudin 2 hours before the next dose of LMWH would have been given
Stop LMWH and start IV bivalirudin 2 hours before the next dose of LMWH would have been given
Stop fondaparinux and start IV bivalirudin 2 hours before the next dose of fondaparinux would have been given
To LMWH SQ Q24H Stop IV heparin and start LMWH at the same time Stop SQ heparin and start LMWH at the time the next dose of SQ heparin would have been given
Stop bivalirudin and start LMWH at the same time
Give next dose of LMWH 24 hours after the last dose was given
Stop fondaparinux and give first dose of LMWH at the time the next dose of fondaparinux would have been given
To LMWH SQ Q12H Stop IV heparin and start LMWH at the same time Stop SQ heparin and start LMWH at the time the next dose of SQ heparin would have been given
Stop bivalirudin and start LMWH at the same time Give next dose of LMWH 12 hours after the last dose was given
Stop fondaparinux and give first dose of LMWH at the time the next dose of fondaparinux would have been given
To Fondaparinux SQ Q24h
Stop IV heparin and start fondaparinux at the same time Stop SQ heparin and start fondaparinux at the same time the next dose of SQ heparin would have been given Stop bivalirudin and start LMWH at the same time Stop LMWH and give first dose of fondaparinux at the time the next dose of LMWH would have been given Stop LMWH and give first dose of fondaparinux at the time the next dose of LMWH would have been given
UWMedicine Anticoagulation Services June 2015
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