Direct Oral Anticoagulant Levels at Time of Elective Surgery

What proportion of patients have elevated residual direct oral anticoagulant (DOAC) levels before an elective procedure when discontinuing treatment according to a standardized protocol (1 day before moderate bleeding-risk procedures and 2 days before high bleeding-risk procedures, with adjustments based on the patient’s kidney function)?In this cohort study of 257 patients, 7.6% had elevated DOAC levels of 30 ng/mL or higher before the procedure. Among those receiving apixaban, this proportion was higher (13.6%).These results suggest that the standardized interruption protocol is associated with DOAC levels below 30 ng/mL, although the proportion of patients with levels of 30 ng/mL or greater was higher among those receiving apixaban.

Corresponding Author: Eleonora Camilleri, MD, PhD, Department of Clinical Epidemiology, Leiden University Medical Center, C7-Q, Albinusdreef 2, 2333ZA Leiden, PO Box 9600, 2300 RC Leiden, the Netherlands (e.camilleri@lumc.nl).

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