ReviewInternal and emergency medicine2018
The vexed question of whether or not to measure levels of direct oral anticoagulants before surgery or invasive procedures.
Review in Internal and emergency medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed.
- [Treatment of proximal femur fractures in patients on direct oral anticoagulants (DOACs) : Review of perioperative management].Unfallchirurgie (Heidelberg, Germany) · 2026Review
- Are the Direct Oral Anticoagulants Better Than Warfarin for the Prevention and Treatment of Stroke and Atrial Fibrillation?Handbook of experimental pharmacology · 2026Review
- Navigating anemia and anticoagulation in elderly patients undergoing orthopedic surgery: strategies for preventing complications and implementing treatments.Blood transfusion = Trasfusione del sangue · 2024Review
- Management of patients with proximal femur fractures under DOACs.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Review
- Therapeutic Drug Monitoring of Direct Oral Anticoagulants in Patients with Extremely Low and High Body Weight-Pilot Study.Journal of clinical medicine · 2023Article
- Review of perioperative outcomes and management of hip fracture patients on direct oral anticoagulants.EFORT open reviews · 2023Review
- Expert Recommendations on the Usage of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) from India: Current Perspective and Future Direction.Cardiology and therapy · 2022Review
- Article
- Patient Characteristics and Preferences Regarding Anticoagulant Treatment in Venous Thromboembolic Disease.Frontiers in cardiovascular medicine · 2021Article
- Position paper on the safety/efficacy profile of direct oral anticoagulants in patients with chronic kidney disease. Consensus document from the SIN, FCSA and SISET.Blood transfusion = Trasfusione del sangue · 2020Article
- Direct oral anticoagulants in lipoprotein apheresis: handle with care.Internal and emergency medicine · 2019Article
- Management of major bleeding and outcomes in patients treated with direct oral anticoagulants: results from the START-Event registry.Internal and emergency medicine · 2018Observational
- A focus on direct oral anticoagulants: "old" and possible new indications and efforts for a better clinical management.Internal and emergency medicine · 2018Article
- A clinical conundrum: to measure or not measure direct oral anticoagulants before a surgery or procedure?Internal and emergency medicine · 2018Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Direct oral anticoagulants (DOAC) possess high bioavailability, and their anticoagulant effect is more predictable than that of vitamin K antagonists, hence they do not require routine dose adjustment based on laboratory testing. However, there are circumstances when laboratory testing may be useful, including patients who need to undergo surgery or invasive procedures. Most guidelines state that patients on DOAC may safely undergo surgery/invasive procedures by stopping anticoagulation for a few days before intervention without testing if renal function is within normal limits. This review article discusses the pros and cons of measuring (or not measuring) DOAC levels before surgery/invasive procedures by a multidisciplinary team of experts with different background, including the thrombosis laboratory, clinical thrombosis, internal medicine, cardiology and nephrology. The conclusion is that measuring DOAC with dedicated tests before surgical or invasive procedures is important for patient safety. It provides the best and most direct evidence to rule in (or to rule out) clinically relevant concentrations of residual drugs. Regulatory agencies should urgently approve their use in clinical practice. Hospital administrators should make them available, and clinical laboratories should set up the relative methods and make them available to clinicians.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.