Predictors of preprocedural direct oral anticoagulant levels in patients having an elective surgery or procedure

The Perioperative Anticoagulation Use for Surgery Evaluation (PAUSE) study prospectively evaluated a prespecified periprocedural-interruption strategy of direct oral anticoagulants (DOACs) among patients with atrial fibrillation. Logistic regression analyses were performed to identify clinical parameters associated with residual DOAC levels >= 30 ng/mL or >= 50 ng/mL. Patients undergoing low-bleed-risk procedures were more likely to have residual levels of >= 30 ng/mL and $50 ng/mL. For low-risk procedures, age >= 75 years, female sex, a creatinine clearance (CrCl),50 mL/min, and an interruption of <36 hours were associated with a greater likelihood of levels >= 30 ng/mL, whereas age >= 75 years, female sex, a CrCl of ,50 mL/min, and standard DOAC dosing were associated with levels >50 ng/mL. For high-risk procedures, weight of <70 kg, CrCl <50 mL/min, and standard DOAC dosing were associated with residual levels >= 30 ng/mL, whereas female sex was associated with levels >= 50 ng/mL. For low-risk procedures, apixaban was associated with a higher likelihood of levels >= 30 ng/mL as compared with dabigatran (P = .0019) and of levels >= 50 ng/mL when compared with rivaroxaban (P = .0003). For high-risk procedures, apixaban was marginally associated with a higher likelihood of residual levels >= 30 ng/mL when compared with dabigatran (P = .05), whereas rivaroxaban was associated with a higher likelihood of levels >= 30 ng/mL as compared with apixaban. Further study is required to determine whether adjustments to perioperative plans based on these clinical parameters could result in a lower risk of residual DOAC levels.