{"id":30169,"date":"2026-04-15T04:33:00","date_gmt":"2026-04-14T20:33:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=30169"},"modified":"2026-04-15T05:57:25","modified_gmt":"2026-04-14T21:57:25","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%8b%a9%e6%9c%9f%e6%89%8b%e6%9c%af%e6%97%b6%e7%9b%b4%e6%8e%a5%e5%8f%a3%e6%9c%8d%e6%8a%97%e5%87%9d%e8%8d%af%e7%9a%84%e6%b0%b4%e5%b9%b3","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=30169","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u62e9\u671f\u624b\u672f\u65f6\u76f4\u63a5\u53e3\u670d\u6297\u51dd\u836f\u7684\u6c34\u5e73"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Surgery<\/p>\n\n\n\n

Direct Oral Anticoagulant Levels at Time of Elective Surgery<\/h1>\n\n\n\n

Eleonora Camilleri, Payam Shahbabai, Mandana Rad, et al<\/h3>\n\n\n\n

JAMA Netw Open 2026;9;(2):e2555875. doi:10.1001\/jamanetworkopen.2025.55875<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  What proportion of patients have elevated residual direct oral anticoagulant (DOAC) levels before an elective procedure when discontinuing treatment according to a standardized protocol (1 day before moderate bleeding-risk procedures and 2 days before high bleeding-risk procedures, with adjustments based on the patient\u2019s kidney function)?<\/p>\n\n\n\n

Findings<\/strong>  In this cohort study of 257 patients, 7.6% had elevated DOAC levels of 30 ng\/mL or higher before the procedure. Among those receiving apixaban, this proportion was higher (13.6%).<\/p>\n\n\n\n

Meaning<\/strong>  These results suggest that the standardized interruption protocol is associated with DOAC levels below 30 ng\/mL, although the proportion of patients with levels of 30 ng\/mL or greater was higher among those receiving apixaban.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Before elective surgery, direct oral anticoagulants (DOACs) are discontinued following a standardized protocol. However, this could result in insufficient lowering of DOAC levels that could increase bleeding risk.<\/p>\n\n\n\n

Objective<\/strong>  To estimate the proportion of patients with elevated DOAC levels at the time of elective surgery, evaluate factors associated with DOAC levels, and examine associated blood loss.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This cohort study (DOAC Level Prior to Incision [DALI]) assessed adult patients prescribed a DOAC (apixaban, dabigatran, or rivaroxaban) for any indication and at any dose, undergoing an elective procedure requiring DOAC interruption between May 27, 2018, and February 25, 2024, at 2 Dutch hospitals.<\/p>\n\n\n\n

Exposure<\/strong>  Standardized interruption protocol (1 day before moderate- and 2 days before high bleeding-risk procedures) with interruption adjustments for the patient\u2019s kidney function.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  Blood was drawn immediately before surgery to determine DOAC levels (by liquid chromatography\u2013mass spectrometry). Proportions of preoperative DOAC levels of 30 ng\/mL or higher and their 95% CIs were estimated, stratified by DOAC type and surgical bleeding risk. Factors associated with DOAC levels were identified through multivariable linear regression. Surgical blood loss and 30-day postoperative complications were described according to DOAC concentrations.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0The study was terminated after including 257 patients (100 receiving apixaban, 100 receiving rivaroxaban, and 57 receiving dabigatran due to the slow inclusion rate of those receiving dabigatran; median [IQR] age, 72 [66-78] years; 173 male [67%]); 212 patients (82%) underwent a high bleeding-risk operation. Preprocedural DOAC levels were 30 ng\/mL or higher in 7.6% (95% CI, 4.9%-11.6%) of patients. Dabigatran and rivaroxaban had similar proportions, whereas 13.1% (95% CI, 7.8%-21.2%) of patients treated with apixaban had levels of 30 ng\/mL or higher. Treatment with apixaban, decreased kidney function, and a shorter interruption time were associated with higher levels. Surgical blood loss (median [range], 0 [0-4250] mL) was not associated with DOAC levels. Twelve patients (4.7%; 95% CI, 2.7%-8.0%), who all had DOAC levels less than 30 ng\/mL, experienced major bleeding.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong>  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.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Surgery Direct Oral Antico […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30169"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=30169"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30169\/revisions"}],"predecessor-version":[{"id":30565,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30169\/revisions\/30565"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=30169"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=30169"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=30169"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}