Quantifying time from last dose: do direct oral anticoagulant assays correlate with patient's reported last dose

Brandon Stretton; Joshua Kovoor; Stephen Bacchi; Aashray Gupta; Suzanne Edwards; Jir Ping Boey; Samuel Gluck; Benjamin Reddi; Guy Maddern; Mark Boyd

doi:10.1097/MBC.0000000000001254

Quantifying time from last dose: do direct oral anticoagulant assays correlate with patient's reported last dose

Brandon Stretton, Joshua Kovoor, Stephen Bacchi, Aashray Gupta, Suzanne Edwards, Jir Ping Boey, Samuel Gluck, Benjamin Reddi, Guy Maddern, Mark Boyd

Research output: Contribution to journal › Article › peer-review

Abstract

Introduction

In the absence of a patient's last direct oral anticoagulant (DOAC) dose time, best practice regarding preoperative DOAC cessation remains unclear. The aim of this study was to investigate, in a real-life patient cohort, if there was an association between subjective patient recall and objective DOAC assay titre.

Methods/Materials

A multicentre cohort study of consecutive surgical inpatients was conducted. DOAC assays were 'expected' if they satisfied both time and titre-based guidelines.

Results

Patient-recalled last dose and DOAC assay was available in 285 individuals. DOAC assay titres correlated strongly with the expected levels based on a patient's reported last dose time(rho=0.70, P value < 0.0001). However, underweight (<50kg; P=0.0339) and elderly (>80years; P=0.0134) were more likely to have an unexpectedly high assay titre.

Conclusions

A significant portion (∼25%) of patients had unexpected DOAC titres. DOAC levels can be clinically impactful in a significant percentage of patients, particularly in elderly and/or underweight.

Original language	English
Pages (from-to)	451-455
Number of pages	5
Journal	Blood Coagulation and Fibrinolysis
Volume	34
Issue number	7
DOIs	https://doi.org/10.1097/MBC.0000000000001254
Publication status	Published - Oct 2023
Externally published	Yes

Keywords

cardiovascular pharmacology
dose-response relationship
drug
pharmacokinetics
thrombosis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/MBC.0000000000001254Licence: In Copyright

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@article{146ebc0bda5c409a9cb597529ee41ed3,

title = "Quantifying time from last dose: do direct oral anticoagulant assays correlate with patient's reported last dose",

abstract = "IntroductionIn the absence of a patient's last direct oral anticoagulant (DOAC) dose time, best practice regarding preoperative DOAC cessation remains unclear. The aim of this study was to investigate, in a real-life patient cohort, if there was an association between subjective patient recall and objective DOAC assay titre.Methods/MaterialsA multicentre cohort study of consecutive surgical inpatients was conducted. DOAC assays were 'expected' if they satisfied both time and titre-based guidelines.ResultsPatient-recalled last dose and DOAC assay was available in 285 individuals. DOAC assay titres correlated strongly with the expected levels based on a patient's reported last dose time(rho=0.70, P value < 0.0001). However, underweight (<50kg; P=0.0339) and elderly (>80years; P=0.0134) were more likely to have an unexpectedly high assay titre.ConclusionsA significant portion (∼25%) of patients had unexpected DOAC titres. DOAC levels can be clinically impactful in a significant percentage of patients, particularly in elderly and/or underweight.",

keywords = "cardiovascular pharmacology, dose-response relationship, drug, pharmacokinetics, thrombosis",

author = "Brandon Stretton and Joshua Kovoor and Stephen Bacchi and Aashray Gupta and Suzanne Edwards and Boey, {Jir Ping} and Samuel Gluck and Benjamin Reddi and Guy Maddern and Mark Boyd",

year = "2023",

month = oct,

doi = "10.1097/MBC.0000000000001254",

language = "English",

volume = "34",

pages = "451--455",

journal = "Blood Coagulation and Fibrinolysis",

issn = "0957-5235",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "7",

}

TY - JOUR

T1 - Quantifying time from last dose

T2 - do direct oral anticoagulant assays correlate with patient's reported last dose

AU - Stretton, Brandon

AU - Kovoor, Joshua

AU - Bacchi, Stephen

AU - Gupta, Aashray

AU - Edwards, Suzanne

AU - Boey, Jir Ping

AU - Gluck, Samuel

AU - Reddi, Benjamin

AU - Maddern, Guy

AU - Boyd, Mark

PY - 2023/10

Y1 - 2023/10

N2 - IntroductionIn the absence of a patient's last direct oral anticoagulant (DOAC) dose time, best practice regarding preoperative DOAC cessation remains unclear. The aim of this study was to investigate, in a real-life patient cohort, if there was an association between subjective patient recall and objective DOAC assay titre.Methods/MaterialsA multicentre cohort study of consecutive surgical inpatients was conducted. DOAC assays were 'expected' if they satisfied both time and titre-based guidelines.ResultsPatient-recalled last dose and DOAC assay was available in 285 individuals. DOAC assay titres correlated strongly with the expected levels based on a patient's reported last dose time(rho=0.70, P value < 0.0001). However, underweight (<50kg; P=0.0339) and elderly (>80years; P=0.0134) were more likely to have an unexpectedly high assay titre.ConclusionsA significant portion (∼25%) of patients had unexpected DOAC titres. DOAC levels can be clinically impactful in a significant percentage of patients, particularly in elderly and/or underweight.

AB - IntroductionIn the absence of a patient's last direct oral anticoagulant (DOAC) dose time, best practice regarding preoperative DOAC cessation remains unclear. The aim of this study was to investigate, in a real-life patient cohort, if there was an association between subjective patient recall and objective DOAC assay titre.Methods/MaterialsA multicentre cohort study of consecutive surgical inpatients was conducted. DOAC assays were 'expected' if they satisfied both time and titre-based guidelines.ResultsPatient-recalled last dose and DOAC assay was available in 285 individuals. DOAC assay titres correlated strongly with the expected levels based on a patient's reported last dose time(rho=0.70, P value < 0.0001). However, underweight (<50kg; P=0.0339) and elderly (>80years; P=0.0134) were more likely to have an unexpectedly high assay titre.ConclusionsA significant portion (∼25%) of patients had unexpected DOAC titres. DOAC levels can be clinically impactful in a significant percentage of patients, particularly in elderly and/or underweight.

KW - cardiovascular pharmacology

KW - dose-response relationship

KW - drug

KW - pharmacokinetics

KW - thrombosis

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U2 - 10.1097/MBC.0000000000001254

DO - 10.1097/MBC.0000000000001254

M3 - Article

C2 - 37756218

AN - SCOPUS:85173620610

SN - 0957-5235

VL - 34

SP - 451

EP - 455

JO - Blood Coagulation and Fibrinolysis

JF - Blood Coagulation and Fibrinolysis

IS - 7

ER -

Quantifying time from last dose: do direct oral anticoagulant assays correlate with patient's reported last dose

Abstract

Keywords

UN SDGs

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