Switching from Warfarin to a DOAC: What to Expect and How to Do It Safely

Switching from Warfarin to a DOAC: What to Expect and How to Do It Safely

For years, warfarin was the main oral anticoagulant available to prevent blood clots and strokes in patients with atrial fibrillation, deep vein thrombosis (DVT), or pulmonary embolism (PE). In recent years, newer medications known as direct oral anticoagulants (DOACs), such as apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), and edoxaban (Savaysa), have become common alternatives.

If you’re currently on warfarin, your doctor may suggest switching to a DOAC because they are easier to manage, have fewer food interactions, and require no routine INR monitoring. But making the switch safely is important, this guide explains how the transition works and what to expect.

Why switch from warfarin to a DOAC?

DOACs offer several advantages over warfarin, including:

  • No regular INR checks — fewer clinic visits.
  • Predictable dosing — most patients take the same dose daily.
  • Fewer food restrictions — vitamin K intake doesn’t interfere with the drug.
  • Faster onset and offset — therapeutic levels are reached within hours instead of days.

For many patients, switching can also improve quality of life and reduce the burden of blood testing.

How your doctor decides if the switch is right for you

Not everyone on warfarin is a good candidate for a DOAC. Your doctor will review:

  • Kidney function — some DOACs require dose adjustments or may be avoided if kidney function is severely reduced.
  • Liver function — certain DOACs are not recommended in moderate to severe liver disease.
  • Indication for anticoagulation — DOACs are not always suitable for patients with mechanical heart valves or certain clotting disorders.
  • Other medications — some drugs may interact with DOACs and require dose adjustments.
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The step-by-step transition process

Switching from warfarin to a DOAC involves timing the change to avoid gaps in anticoagulation (which could increase clot risk) or overlap (which could increase bleeding risk).

1. Stop warfarin and monitor INR:
Your doctor will have you stop warfarin and check your INR daily or every other day. The goal is to start the DOAC once your INR falls below a certain threshold.

2. INR thresholds for switching

3. Start the DOAC promptly
Once your INR is at the target, start the DOAC that same day, no overlap with warfarin is needed.

4. Follow up after the switch
Your doctor may check kidney function, review side effects, and assess any changes in bleeding or clotting symptoms within the first month.

avoiding INR testing with DOAC

What changes after the switch

  • No more INR checks — although you may still need occasional kidney and liver function tests.
  • Same daily dose — most DOACs are taken once or twice daily at a fixed dose.
  • Faster effect — DOACs begin working within hours of your first dose, compared to warfarin’s several-day delay.

Monitoring for side effects

While DOACs generally cause fewer side effects than warfarin, you should watch for:

  • Unexpected bruising
  • Nosebleeds or bleeding gums
  • Blood in urine or stool
  • Persistent headaches or dizziness (possible signs of internal bleeding)

If any of these occur, contact your doctor immediately.

Cost considerations

DOACs are often more expensive than warfarin, especially if your insurance doesn’t cover them. If cost is a concern, some patients explore legitimate Canadian pharmacy options, where medications like Eliquis and Xarelto can be significantly cheaper. U.S. patients with a valid prescription can often order from licensed Canadian pharmacies or prescription referral services for personal use.

Final tips for a safe transition

  • Never stop or change anticoagulation therapy without medical supervision.
  • Keep a record of your last warfarin dose and your INR results before starting the DOAC.
  • Use a pill organizer or phone reminder to avoid missed doses, DOAC protection wears off quickly if doses are skipped.
  • Inform all your healthcare providers, including dentists, that you’re now on a DOAC.

FAQ

Can I just stop warfarin and start a DOAC the next day?
No, you need to wait until your INR is below the threshold for your specific DOAC. Starting too soon increases bleeding risk. Always discuss with your doctor.

Do I need to bridge with injections when switching?
No, bridging with low molecular weight heparin (LMWH) is not needed when transitioning from warfarin to a DOAC, but your doctor will discuss this further.

Are DOACs safer than warfarin?
They generally have a lower risk of brain bleeding, but bleeding risk is still present and varies by patient.

Will I save money switching to a DOAC?
Warfarin is usually cheaper, but DOACs may save you money indirectly by avoiding frequent INR testing. Patients without insurance coverage sometimes find DOACs for less through Canadian pharmacies.

Disclaimer: This article is for informational purposes only and not medical advice. Consult a licensed healthcare provider before starting or changing medications. Use reputable, licensed pharmacies to ensure safety.