Predictors of Plasma Levels of Direct Oral Anticoagulants Among Patients with Atrial Fibrillation in Need of Elective Cardiac Procedures
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View abstract on PubMed
Summary
This summary is machine-generated.Direct oral anticoagulant (DOAC) levels are frequently outside the target range in atrial fibrillation patients undergoing cardiac procedures. Inappropriate withdrawal timing and increased creatinine clearance predict low DOAC levels, while diabetes predicts high levels.
Area Of Science
- Cardiology
- Pharmacology
- Clinical Medicine
Background
- Direct oral anticoagulants (DOACs) require precise withdrawal timing before surgery based on pharmacokinetics to avoid peak plasma concentrations.
- Atrial fibrillation (AF) patients on DOACs undergoing elective cardiac procedures present challenges in managing anticoagulant levels.
- Understanding the prevalence and predictors of out-of-range DOAC plasma levels is crucial for procedural safety.
Purpose Of The Study
- To determine the prevalence of out-of-range direct oral anticoagulant (DOAC) plasma levels in atrial fibrillation (AF) patients undergoing elective cardiac procedures.
- To identify clinical predictors associated with DOAC plasma concentrations falling below or exceeding the therapeutic trough range.
Main Methods
- A cohort of 90 consecutive AF patients on DOAC therapy scheduled for elective cardiac procedures was evaluated.
- DOAC plasma levels were measured on the morning of the procedure and categorized as in range, above range, or below range.
- Clinical data were collected to identify predictors of out-of-range DOAC levels, including drug withdrawal timing and renal function.
Main Results
- A high prevalence (82.22%) of out-of-range DOAC plasma levels was observed in the study population.
- DOAC levels below the trough range were predicted by longer inappropriate drug withdrawal periods and increased creatinine clearance.
- DOAC levels above the trough range were predicted by the presence of diabetes mellitus.
Conclusions
- DOAC plasma levels frequently fall outside the therapeutic range in AF patients undergoing cardiac procedures.
- Inappropriate longer drug withdrawal and elevated creatinine clearance are key predictors for sub-therapeutic DOAC levels.
- Diabetes mellitus is a significant predictor for supra-therapeutic DOAC levels, necessitating careful management.
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