Anticoagulants are commonly used in intensive care units (ICUs). Patients may need to transition from one anticoagulant medication to another because of changes in clinical status such as planned or emergency procedures, lack of enteral access, concern for heparin-induced thrombocytopenia (HIT), change in renal or hepatic function, or drug-drug interactions. As the number of anticoagulants available to clinicians has grown, understanding how to transition between agents has become more important. There are no randomized controlled trials comparing strategies for transitioning between agents, so guidance for transitioning between anticoagulants is mostly extrapolated from pharmacokinetic parameters. Proper transitioning from one agent to another can minimize the risk of bleeding or clotting events.

Because oral anticoagulants have longer half-lives than parenteral options, they are commonly administered to patients once they are clinically stable rather than before, as they may need to undergo surgical procedures. Oral anticoagulants...

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