When switching from one DOAC to another DOAC, should you overlap therapy?

When switching from one DOAC to another DOAC, should you overlap therapy?

• A. Do not overlap
• B. Overlap with a bridging agent
• C. Overlap for 24 hours
• D. Overlap until the next dose is due

Answer: (A)

The main idea is that switching between DOACs should be done without overlap. Each DOAC provides rapid onset and has a relatively short duration of action, so stacking two DOACs at the same time would significantly increase bleeding risk without added benefit. The correct approach is to stop the first DOAC and start the second DOAC at the time the second agent would be due, ensuring continuous protection without overlap. Bridging with a parenteral agent is not required when moving between DOACs. If a procedure or special circumstance arises, follow per-drug hold guidelines, but for routine switching there’s no overlap.

The main idea is that switching between DOACs should be done without overlap. Each DOAC provides rapid onset and has a relatively short duration of action, so stacking two DOACs at the same time would significantly increase bleeding risk without added benefit. The correct approach is to stop the first DOAC and start the second DOAC at the time the second agent would be due, ensuring continuous protection without overlap. Bridging with a parenteral agent is not required when moving between DOACs. If a procedure or special circumstance arises, follow per-drug hold guidelines, but for routine switching there’s no overlap.