ArticleJournal of thrombosis and thrombolysis2018
Direct-acting oral anticoagulant drug level monitoring in clinical patient management.
Article in Journal of thrombosis and thrombolysis, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 44 citations in OpenAlex.
- Utilization of Apixaban Pharmacokinetics for Dose Optimization in High-Risk Elderly Patients.Clinical pharmacokinetics · 2026Observational
- Measuring Direct Oral Anticoagulant (DOAC) Levels: Applications, Limitations, and Future Directions.International journal of laboratory hematology · 2026Review
- Direct Oral Anticoagulant Transition Strategies Using Anti-Xa Concentrations Upon Intensive Care Unit Admission.The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians · 2026Article
- Measurement of plasma direct oral anticoagulants concentrations in real-world clinical and laboratory settings on a 24/7 basis: a 10-year experience.Journal of thrombosis and thrombolysis · 2026Article
- Systematic Scoping on Point-of-care Monitoring of Direct Oral Anticoagulants in Patients with Non-valvular Atrial Fibrillation: Current Status and Future Perspectives in Malaysia.European cardiology · 2025Review
- To Measure or Not to Measure: Direct Oral Anticoagulant Laboratory Assay Monitoring in Clinical Practice.Advances in hematology · 2023Article
- [Coagulation diagnostics in the clinical routine-part 2 : Monitoring of anticoagulation treatment, new-onset thrombocytopenia and thrombophilia].Innere Medizin (Heidelberg, Germany) · 2022Article
- The Perioperative Management of Antiplatelet and Anticoagulant Drugs in Hip Fractures: Do the Surgery as Early as Possible.The archives of bone and joint surgery · 2022Review
- Variation in Plasma Levels of Apixaban and Rivaroxaban in Clinical Routine Treatment of Venous Thromboembolism.Life (Basel, Switzerland) · 2022Article
- 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2021Article
- Lead thrombus under standard-dose edoxaban in a patient with normal to high creatinine clearance and protein S deficiency.Thrombosis journal · 2021Article
- Article
- Rivaroxaban Precision Dosing Strategy for Real-World Atrial Fibrillation Patients.Clinical and translational science · 2020Article
- Monitoring of low dabigatran concentrations: diagnostic performance at clinically relevant decision thresholds.Journal of thrombosis and thrombolysis · 2020Observational
- Drug interactions and pharmacogenetic factors contribute to variation in apixaban concentration in atrial fibrillation patients in routine care.Journal of thrombosis and thrombolysis · 2020Observational
- An algorithmic approach to gastrointestinal bleeding in patients receiving antithrombotic agents.Gastroenterology and hepatology from bed to bench · 2020Review
- Exposure Response Supports Therapeutic Drug Monitoring for Dabigatran Etexilate in Patients with Atrial Fibrillation.TH open : companion journal to thrombosis and haemostasis · 2019Article
- Management strategies of the interaction between direct oral anticoagulant and drug-metabolizing enzyme inducers.Journal of thrombosis and thrombolysis · 2019Article
- Drug interaction as a predictor of direct oral anticoagulant drug levels in atrial fibrillation patients.Journal of thrombosis and thrombolysis · 2018Article
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The role of drug-level monitoring among patients using direct-acting oral anticoagulant (DOAC) is unclear. We aimed to investigate its 'real-life' utilization and effect on clinical management. A review of records of patients who underwent DOAC level testing during 2013-2017. Overall, 212 patients (median age 77 years) underwent 292 DOAC measurements [apixaban (n = 147), rivaroxaban (n = 102), dabigatran (n = 43)]. Monitoring volume increased by 460% during study period. DOAC level testing was performed during routine follow-up in 51 (17.5%) cases, whereas the remaining 241 (82.5%) measurements were performed due to selected clinical circumstances, most commonly: bleeding (n = 60), perioperative status (n = 45), breakthrough thrombosis (n = 37) and renal failure (n = 35). Drug levels were within the expected range in 210 (71.9%), above the expected range in 62 (21.2%) and lower than expected range in 20 (6.8%). In multivariate analysis, older age (P = 0.005), lower glomerular filtration rate (P = 0.001) and lower body mass index (P = 0.006) were associated with DOAC levels above the expected range. Clinical decisions were affected by DOAC monitoring following most (140/241, 58.1%) measurements for which we identified an indication for testing; yet only rarely when monitoring was performed during routine follow-up (7.8%, 4/51) (P < 0.0001). While no benefit of routine DOAC monitoring was observed, drug level measurement has an important role in the management of patients in selected circumstances. Age, body weight and creatinine clearance were found to be significant predictors of drug levels. Future studies are warranted to establish associations between drug levels and outcomes, and better delineate the role of DOAC monitoring.
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Registered trials
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