Hemodynamics, fluids & transfusion
Direct Oral Anticoagulant Levels at Time of Elective Surgery
- terminated early (slow dabigatran inclusion)
Authors' conclusion
In this cohort study, most patients following the current protocol had DOAC levels less than 30 ng/mL, although the proportion of patients with elevated levels was higher for apixaban. Preoperative DOAC levels were not associated with blood loss during surgery.
Study context
- Population
- Adults on a DOAC (apixaban, dabigatran or rivaroxaban) undergoing elective procedures requiring DOAC interruption, 2 Dutch hospitals, 2018–2024212 (82%) high bleeding-risk
- Participants
- 257 adults
- Exposure
- Preoperative DOAC levels by DOAC type after standardized interruption
- Apixabann = 100
- Rivaroxabann = 100
- Dabigatrann = 57
- Outcome
- Proportion with preoperative DOAC level ≥30 ng/mL (blood drawn immediately before surgery)
- Follow-up
- Immediately before surgery
Methodological detailsmulticentre (2 Dutch hospitals), Terminated after 257 patients due to slow inclusion of dabigatran patients
- Multicentre (2 Dutch hospitals)
- Terminated after 257 patients due to slow inclusion of dabigatran patients
Main finding
As reported in the abstract
Preoperative DOAC level ≥30 ng/mL
Apixaban
13.1%
95% CI 7.8%–21.2%
- All patients with DOAC level ≥30 ng/mL
- 7.6% (95% CI, 4.9%-11.6%)
Observational data: associations, not effects.
Further findings
Factors associated with DOAC levels
- Apixaban, decreased kidney function and shorter interruption time associated with higher levels
Surgical blood loss
- Surgical blood loss, median [range], mL
- 0 [0-4250]
- Not associated with DOAC levels
Safety
- Major bleeding, all with DOAC levels <30 ng/mL
- 12 (4.7%; 95% CI, 2.7%-8.0%)
Original publication
Direct Oral Anticoagulant Levels at Time of Elective Surgery. JAMA Netw Open. Published 2 February 2026. doi:10.
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