Making up for Lost Time: Perioperative Direct Oral Anticoagulant Assay
Current evidence and guidelines suggest a time-based approach to the
perioperative administration of direct oral anticoagulants (DOAC).
Quantifying haematological concentrations of DOACs is possible however,
the evidence suggests a large inter-individual variation and unlike INR
is to warfarin, it does no correlation with anticoagulant effect. There
are multiple confounding factors that affect DOAC metabolism and may
result in a cohort of patients who satisfy one guideline (time based)
but are ruled out using an objective, serum quantity-based guideline.
The unsubstantiated use of DOAC level testing to inform surgical triage
and use of reversal agents preoperatively may increase harm to patients.