Retrospective study of clinical settings, indications and consequences of measurement of direct oral anticoagulant plasma levels in Northern Tasmania, Australia
Research article published in Internal medicine journal (2024)
Abstract
BACKGROUND: Routine monitoring of direct oral anticoagulant (DOAC) levels is not recommended but may be useful in certain clinical situations. There is a knowledge gap regarding the clinical use of DOAC levels in Australian hospitals. AIMS: To evaluate the clinical settings, indications and changes to anticoagulant management associated with DOAC levels in a tertiary hospital in Northern Tasmania, Australia. METHODS: Patients with one or more DOAC levels (dabigatran, rivaroxaban or apixaban) requested between January 2017 and December 2022 were identified. Retrospective chart review was performed to evaluate the clinical settings, indications, adequacy of request information and changes to clinical management associated with the measurement of DOAC levels. RESULTS: One hundred and twenty-nine DOAC measurements (54 rivaroxaban, 66 apixaban and nine dabigatran) were performed in 98 patients between January 2017 and December 2022. Annual requests for DOAC levels increased significantly between 2017 and 2019 and remained stable between 2020 and 2021 but declined in 2022. Overall, the most common indication for a DOAC level was renal impairment, followed by bleeding and recurrent thrombosis. Approximately 25% of requests were for acute bleeding with a reversal/haemostatic agent given in 45% of patients, while 10% were prior to urgent surgery. Measurement of DOAC levels was associated with a change in management in 50% of cases. 10% of requests did not specify anticoagulant history. CONCLUSION: Trends in requests for DOAC levels have changed over time. Clinician education regarding the importance of providing specific anticoagulant history is essential. Future prospective studies investigating the clinical utility of DOAC levels in different clinical settings are needed.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to anticoagulation, leech therapy, and microsurgical flap management. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This retrospective chart review of 129 direct oral anticoagulant (DOAC) plasma-level measurements in 98 patients at a Tasmanian tertiary hospital (2017-2022) found that, although routine DOAC monitoring is not recommended, levels were most often requested for renal impairment, bleeding, and recurrent thrombosis, that roughly a quarter of requests involved acute bleeding (with a reversal/haemostatic agent given in 45%), and that measurement changed management in about half of cases. For hirudotherapy it provides context on the real-world difficulty of monitoring and reversing modern systemic anticoagulants, a backdrop to discussions of locally applied antithrombotic approaches such as medicinal leeching. As a small, single-center retrospective study, it describes practice patterns rather than clinical effectiveness, calls for prospective work itself, and has no direct connection to leech therapy.
Citation
Retrospective study of clinical settings, indications and consequences of measurement of direct oral anticoagulant plasma levels in Northern Tasmania, Australia.
Lim et al. · Internal medicine journal, 2024
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