Observational studyJournal of thrombosis and haemostasis : JTH2019
Drug levels and bleeding complications in atrial fibrillation patients treated with direct oral anticoagulants.
Observational study in Journal of thrombosis and haemostasis : JTH, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 1 of them a synthesis that pooled it.
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Who cites it
56 citing papers in PubMed, 1 synthesis or guideline pooled it, 129 citations in OpenAlex.
- Usual On-therapy Ranges of Drug Concentrations in Patients with Atrial Fibrillation Treated with Direct Oral Anticoagulants: A Systematic Review and Meta-analysis.Thrombosis and haemostasis · 2025Pooled it
- Pharmacogenomic profiling of ABCB1 and CES1 in atrial fibrillation patients on dabigatran from a multiethnic Malaysian cohort.Scientific reports · 2026Article
- Direct Oral Anticoagulant Levels at Time of Elective Surgery.JAMA network open · 2026Article
- 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
- Therapeutic Drug Monitoring of Direct Oral Anticoagulants and Its Association with Clinical Outcomes: A Systematic Review and Meta-Analysis.Pharmaceuticals (Basel, Switzerland) · 2026Review
- Healthcare professionals' perspectives on prescribing DOACs to frail older patients; the DOAC-FRAIL questionnaire.BMC geriatrics · 2026Article
- Are the Direct Oral Anticoagulants Better Than Warfarin for the Prevention and Treatment of Stroke and Atrial Fibrillation?Handbook of experimental pharmacology · 2026Review
- Perioperative management of colorectal surgical patients receiving a direct oral anticoagulant: a scoping review, particular emphasis on procedure-specific risks, and pharmacogenomics.Frontiers in cardiovascular medicine · 2026Review
- Re: Systematic Scoping on Point-of-care Monitoring of Direct Oral Anticoagulants in Non-valvular Atrial Fibrillation.European cardiology · 2026Article
- A review of the use of oral anticoagulants in individuals with atrial fibrillation who had experienced intracranial hemorrhage in the past.International journal of physiology, pathophysiology and pharmacology · 2025Review
- 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
- Thrombotic events associated with low baseline direct oral anticoagulant levels in atrial fibrillation: the MAS study.Blood advances · 2024Observational
- Clot time ratio (CTR) and relation to treatment outcome in patients with atrial fibrillation treated with Rivaroxaban.Thrombosis journal · 2024Article
- The wonders of anticoagulation.Frontiers in cardiovascular medicine · 2024Article
- Impact of renal function variability on long-term prognosis in ischemic stroke patients with atrial fibrillation.Frontiers in neurology · 2024Article
- Effect of low-dose rivaroxaban on bleeding events in low-weight patients with nonvalvular atrial fibrillation: a retrospective propensity score-matched cohort study.Frontiers in cardiovascular medicine · 2024Article
- Simvastatin, but Not Atorvastatin, Is Associated with Higher Peak Rivaroxaban Serum Levels and Bleeding: an Asian Cohort Study from Singapore.Cardiovascular drugs and therapy · 2023Article
- Antithrombotic Treatment in Patients With Hemophilia: an EHA-ISTH-EAHAD-ESO Clinical Practice Guidance.HemaSphere · 2023Article
- Safety and Efficacy Re-Evaluation of Edoxaban and Rivaroxaban Dosing With Plasma Concentration Monitoring in Non-Valvular Atrial Fibrillation: With Observations of On-Label and Off-Label Dosing.Circulation reports · 2023Article
- TAVR: nemesis of NOACs?Journal of thrombosis and thrombolysis · 2023Article
Corrections and comments
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Authors and funding
13 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Essentials Currently, DOACs are given at fixed doses and do not require laboratory monitoring. Direct oral anticoagulant-specific measurements were performed at trough and peak. Patients who developed bleeding events showed higher DOAC plasma levels at peak. This study suggests the need of a more accurate DOAC dose assessment.
backgroundDirect oral anticoagulants (DOACs) are administered at fixed dose. The aim of the study was to evaluate the relationship between DOAC C-trough or C-peak plasma levels and bleeding complications in patients with non-valvular atrial fibrillation (NVAF).
methodsFive hundred sixty five consecutive naive NVAF patients were enrolled. The DOAC measurements at C-trough and at C-peak (available in 411 patients) were performed at steady state, within the first month of treatment. Major bleeding (MB), clinically relevant non-major bleeding (CRNMB), and minor bleeding (MinB), occurring during 1 year of follow-up after blood sampling, were recorded. For each DOAC, interval of C-trough and C-peak levels was subdivided into four equal classes and results were attributed to these classes; the median values of results were also calculated.
resultsTwo hundred eight patients were on apixaban, 185 on dabigatran, and 172 on rivaroxaban. For 1-[qqqdeletezzz] year follow up for all patients, we observed: 19 MB (3.36%), 6 CRNMB (1.06%), and 47 MinB (8.31%). The prevalence of bleeding patients with anticoagulant levels in the upper classes of C-peak activity (II + III + IV) was higher than that in the lowest class. Normalized results of C-peak levels were higher in patients with bleeding than in those without bleeding.
conclusionsBleeding complications during DOAC treatment were more frequent among atrial fibrillation (AF) patients with higher C-peak anticoagulant levels. In addition to a previous study that showed an increased risk of thrombotic complications in the patients with low C-trough levels, this study seems to indicate that patients with NVAF on DOACs would need a more accurate definition of their optimal therapeutic window.
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