Predictors of pre-procedural concentrations of direct oral anticoagulants: a prospective multicentre study

Abstract

A last DOAC intake 3 days before a procedure resulted in minimal pre-procedural anticoagulant effect for almost all patients. Moderate renal impairment, especially in dabigatran-treated patients, and antiarrhythmics in anti-Xa-treated patients should result in a longer DOAC interruption. In situations requiring testing, routine assays should not replace DOAC concentration measurement.

A level‐headed approach to measuring direct oral anticoagulants: A 2‐year retrospective analysis of DOAC levels from a tertiary UK centre

“…Given this variation in trough DOAC level, it is recommended that patients stop taking their DOAC anywhere between 24 and 120 hours prior to surgery, depending on the DOAC, renal function, concomitant medication and bleeding risk . However, there are only limited studies assessing DOAC concentrations following a period of omission pre‐operatively . For example, Douketis et al investigated the effect of a standardized protocol of stopping dabigatran pre‐operatively in 181 patients taking dabigatran for AF and requiring elective surgery.…”

“…Even so, 27 patients still had levels of ≥41 ng/mL dabigatran at the time of surgery; 5 of whom underwent a procedure with a high bleeding risk . Similarly, in a study by Godier et al, a small proportion of patients taking a DOAC and undergoing either elective or urgent surgery still had a DOAC level of >50 ng/mL after >72 . This threshold is important as it is recommended that reversal agent usage is considered if urgent operative intervention of any bleeding risk is required …”

Intravenous thrombolysis for acute ischaemic stroke in patients on direct oral anticoagulants

“…The TT is very sensitive to dabigatran, being unmeasurable in most patients on treatment, and is moderately prolonged even when the plasmatic concentration of dabigatran is low (≤30 ng/ml). Thus, a normal TT reliably rules out the presence of dabigatran, and for TT ≤60 s dabigatran levels are low (<30 ng/ml) . A similar reasoning applies when measuring anti‐Xa activity, calibrated in heparin/low‐molecular‐weight heparin (heparin/LMWH) anti‐Xa units.…”

Periprocedural management of anticoagulation for atrial fibrillation catheter ablation in direct oral anticoagulant–treated patients

“…This was a post hoc analysis of the Preprocedural Concentration of Direct Oral Anticoagulants (CORIDA) study (http://www.clinicaltrials.gov NCT02643992), a prospective, multicenter cohort study including DOAC‐treated patients requiring any invasive procedure . The aim of the main study was to investigate the factors influencing preprocedural DOAC concentration.…”

“…gov NCT02643992), a prospective, multicenter cohort study including DOAC-treated patients requiring any invasive procedure. 12 The aim of the main study was to investigate the factors influencing preprocedural DOAC concentration. In the present study, we focused on patients who required catheter ablation, and we specifically analyzed…”