Stretton Brandon, Kovoor Joshua, Bacchi Stephen, Gupta Aashray, Edwards Suzanne, Boey Jir Ping, Gluck Samuel, Reddi Benjamin, Maddern Guy, Boyd Mark
Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia.
Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.
Hosp Pract (1995). 2025 Feb;53(1):2433937. doi: 10.1080/21548331.2024.2433937. Epub 2024 Dec 1.
There is a lack of evidence regarding direct oral anticoagulant (DOAC) assay plasma concentrations and their association with bleeding events or transfusion requirements. This multicenter study aimed to characterize the use and plasma levels of DOAC assays of anticoagulated patients who present to emergency with a bleeding event and their association with bleeding severity.
A multicenter retrospective cohort study of consecutive emergency bleeding presentations with a DOAC assay over a five-year period was conducted. Linear regressions were performed for continuous outcomes, binary logistic regression for categorical outcomes.
There were 86 patients on a DOAC, who presented with a major bleeding event, and had a DOAC assay performed. Assays were performed within a median time of 4.8 hours (IQR = 9,14.4) from presentation and had a median result of 122.9 ng/ml(IQR = 42,160). DOAC assay plasma level was not significantly associated with type or severity of bleed however, for every 10 unit increase in DOAC assay plasma level, the odds of administering reversal increases by 4% (OR = 1.04, 95%CI:1.00-1.08).
A wide range of plasma levels can be expected in patients who present with bleeding events. Higher DOAC plasma levels do not necessarily confer a worse bleeding event or increased transfusion requirements; however, it is associated with an increased likelihood of anticoagulant reversal administration.
关于直接口服抗凝剂（DOAC）检测的血浆浓度及其与出血事件或输血需求的关联，目前缺乏证据。这项多中心研究旨在描述因出血事件就诊于急诊科的抗凝患者DOAC检测的使用情况和血浆水平，以及它们与出血严重程度的关联。
进行了一项为期五年的多中心回顾性队列研究，纳入连续因出血事件就诊并接受DOAC检测的患者。对连续型结局进行线性回归分析，对分类结局进行二元逻辑回归分析。
有86例服用DOAC的患者出现了严重出血事件，并进行了DOAC检测。检测在就诊后的中位时间4.8小时（四分位间距=9，14.4）内进行，中位结果为122.9纳克/毫升（四分位间距=42，160）。DOAC检测血浆水平与出血类型或严重程度无显著关联，然而，DOAC检测血浆水平每升高10个单位，给予逆转治疗的几率增加4%（比值比=1.04，95%置信区间：1.00-1.08）。
出现出血事件的患者血浆水平范围较广。较高的DOAC血浆水平不一定意味着更严重的出血事件或增加输血需求；然而，它与抗凝逆转治疗给药可能性增加相关。
