loading page

Making up for Lost Time: Perioperative Direct Oral Anticoagulant Assay Measurements
  • +4
  • Brandon Stretton,
  • Joshua G. Kovoor,
  • Aashray K. Gupta,
  • Christopher Ovenden,
  • Peter Litwin,
  • Guy J. Maddern,
  • Mark Boyd
Brandon Stretton
The University of Adelaide

Corresponding Author:brandon.stretton@adelaide.edu.au

Author Profile
Joshua G. Kovoor
The Queen Elizabeth Hospital
Author Profile
Aashray K. Gupta
The University of Adelaide
Author Profile
Christopher Ovenden
The University of Adelaide
Author Profile
Peter Litwin
Royal Adelaide Hospital
Author Profile
Guy J. Maddern
The University of Adelaide
Author Profile
Mark Boyd
The University of Adelaide
Author Profile

Abstract

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.