lovenox to dabigatran

[MackandBlues]

ok making sure I'm not going crazy.... when starting someone on pradaxa/dabigatran do you need to bridge with lovenox?

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[bacillus1]

ok making sure I'm not going crazy.... when starting someone on pradaxa/dabigatran do you need to bridge with lovenox?

Only for VTE, not for a. fib. This is why we normally choose other DOACs to use for VTE. Also it's not quite a "bridge", as you don't use them together. You use lovenox for 5 days without dabigatran, followed by starting dabigatran. The only time I've ever seen it used was in a patient with HIT, as the team was afraid that rivaroxaban could cross-react (currently not much data on this).

 

[Hands_in_the_Ayr]

Only for VTE, not for a. fib. This is why we normally choose other DOACs to use for VTE. Also it's not quite a "bridge", as you don't use them together. You use lovenox for 5 days without dabigatran, followed by starting dabigatran. The only time I've ever seen it used was in a patient with HIT, as the team was afraid that rivaroxaban could cross-react (currently not much data on this).

That's what I was taught (took a test on it recently). As far as HIT, are you saying that they didn't "bridge" with lovenox (as far as I know, it can cause HIT just as much as heparin could)? Also, seems silly to think that xarelto could cause HIT, but who knows?

 

[bacillus1]

That's what I was taught (took a test on it recently). As far as HIT, are you saying that they didn't "bridge" with lovenox (as far as I know, it can cause HIT just as much as heparin could)? Also, seems silly to think that xarelto could cause HIT, but who knows?

Sorry, I wasn't clear in my previous post. Lovenox would cause HIT. I think they were thinking to bridge with fonda (though both fonda and rivaroxaban have the same MOA, just that rivaroxaban hasn't been studied in HIT). Also, if you really wanted to, you could keep the pt in the hospital for argatroban. I forget what actually transpired, I believe it wasn't the second scenario.