Evidence map›Paper›PMID 39844807›Full record

ReviewSurgery in practice and science2023

Association between direct oral anticoagulant concentrations and clinical outcomes: A systematic review and meta-analysis.

Brandon Stretton, Philip Harford, Joshua Kovoor, Stephen Bacchi, Aashray Gupta, Jaspreet Sandhu, Hollie Moran, Suzanne Edwards, Jonathon Henry W Jacobsen, Guy Maddern and 1 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Surgery in practice and science, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Brandon StrettonAdelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, South Australia, Australia.
Philip HarfordAdelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, South Australia, Australia.
Joshua KovoorAdelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, South Australia, Australia.
Stephen BacchiAdelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, South Australia, Australia.
Aashray GuptaAdelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, South Australia, Australia.
Jaspreet SandhuCentral Adelaide Local Health Network, Adelaide, South Australia, Australia.
Hollie MoranCentral Adelaide Local Health Network, Adelaide, South Australia, Australia.
Suzanne EdwardsAdelaide Health Technology Assessment, The University of Adelaide, Adelaide, South Australia, Australia.
Jonathon Henry W JacobsenResearch, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
Guy MaddernAdelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, South Australia, Australia.
Mark BoydAdelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, South Australia, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Current guidelines suggest preoperative direct oral anticoagulant levels of < 30-50 ng/ml. However, there is limited evidence to guide this expert consensus. Reviewing assay titres and clinical outcomes may be able to inform perioperative care of the anticoagulated patient. This review aimed to determine whether DOAC assay plasma concentrations are associated with bleeding or systemic embolic events to better appreciate a possible therapeutic or hazardous reference range. Methods: Systematic search, performed by an information specialist using a peer-reviewed search. Main search concepts were direct oral anticoagulant therapy for atrial fibrillation or venous thromboembolism. Data synthesised in narrative and tabular format whilst data that could be pooled was subjected to meta-analysis, using a random effects model. Meta regression was conducted for DOAC peak levels and clinical events. PRISMA guidelines were adhered to. Results: Of 6717 retrieved publications, a total of 17 studies were included in the systematic review and 14 in the meta-analysis/regression. Studies report clinical outcome follow up ranging from 28 to 128 weeks. For every 10 ng/ml increase in DOAC assay trough and peak levels, the mean number of bleeding cases increases by 0.03(95 %CI: -0.32 -0.38, Conclusion: There exists no significant, independent relationship, as determined by a univariate meta regression, between DOAC assay concentrations and a patient's risk of bleeding or systemic embolic embolism. This review also highlights the possibility of an absolute, patient specific DOAC assay concentration that may indicate adequate anticoagulation, above which further increases do not confer an increased risk of bleeding. However, further research to characterise this and its utility in the perioperative setting is required.

Indexed as

AnticoagulationBleedingTherapeutic drug monitoringThrombosis

Identifiers

PMID39844807
PMCPMC11749988

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Registered trials

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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.