Before starting edoxaban after stopping warfarin, what INR threshold is required?

• A. INR < 2.5
• B. INR < 2
• C. INR < 3
• D. INR < 1.5

Answer: (A)

When switching from warfarin to edoxaban, you want to avoid overlapping anticoagulant effects. Warfarin’s effect is tracked by the INR, and starting a DOAC like edoxaban while the INR is still high risks excessive bleeding. The safe, recommended moment to begin edoxaban is once the INR has fallen to less than 2.5. At that point the residual warfarin effect is sufficiently reduced, allowing edoxaban to provide anticoagulation without excessive bleeding risk. If you wait longer, you still have protection from the DOAC, but you risk a longer gap; starting before the INR drops below 2.5 would increase bleeding risk due to overlapping effects.