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- Patients admitted to hospital who take warfarin (or any other coumarin anticoagulant), should be considered for a switch to a suitable direct oral anticoagulant (DOAC). This recommendation is based on the reduced bleeding risk with DOACs when compared with warfarin and improved patient acceptability given the lack of need for ongoing monitoring in hospital and community-based clinics.
 - The Appropriate and Safe Conversion from Warfarin to a DOAC guideline available in the GGC Adult Therapeutics Handbook includes full detail, such as situations when patients should not be switched, recommended choice of DOAC and how to switch patients.
 
