I was on coumadin for 10 yrs. and my Doctor switched me to Pradaxa 1 yr. ago and 2 months ago switched me back to Coumadin due to all of the recent concerns. I began to take coumadin again before stopping Pradaxa..If you check on the Pradaxa web site under switching back to Coumadin they advise you to continue taking Pradaxa for a period of time... Do not stop taking Pradaza and then start Coumadin... at least that is not what the directions I followed said to do... I think after 2 full days then you stop the Pradaxa after checking your INR... It worked seemlessly for me but do check with your doctor and check Pradaxa's web site for exact info. on how to make the switch.
When converting from PRADAXA to warfarin, adjust the starting time of warfarin based on creatinine clearance as follows:
• For CrCl ≥50 mL/min, start warfarin 3 days before discontinuing PRADAXA.
• For CrCl 30-50 mL/min, start warfarin 2 days before discontinuing PRADAXA.
• For CrCl 15-30 mL/min, start warfarin 1 day before discontinuing PRADAXA.
• For CrCl <15 mL/min, no recommendations can be made.
Because PRADAXA can contribute to an elevated INR, the INR will better reflect warfarin’s effect after PRADAXA has been stopped for at least 2 days.
Your hematologist or cardiologist should be guiding you through this process and ensuring that your INR is at the correct level. You will need to track what you eat for a little while so that you know what increases your warfarin amount. You should also discuss with your doctor about getting a prescription for a home testing kit so that you can test yourself at home. They will not let you do this for the first 3 months or so but after that there really should not be a problem unless the doctor is looking to make money by doing the testing themselves.
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