Abstract：
Purpose: Describe direct oral anticoagulant (DOAC) level ordering and interpretation practices in association with clinical outcomes at a vascular medicine clinic. Methods: This study was a retrospective, observational study including patients who had a DOAC level ordered and assessed while on DOAC therapy. The primary outcome was the proportion of DOAC levels within previously reported ranges. Secondary outcomes included thrombotic events, major and clinically relevant non-major bleeding events, and the proportion of DOAC level results which prompted a change in the therapeutic plan. Results: A total of 43 patients who had a DOAC level ordered while on DOAC therapy were included in the study. More patients were on apixaban than other DOACs, and the most common indication for anticoagulation was deep vein thrombosis (DVT) or pulmonary embolism (PE). The most common reasons for ordering DOAC levels included history of gastric bypass (n = 20) and drug-drug interactions (n = 8). Most patients on apixaban had in-range levels (n = 24) compared to out of-range levels (5 patients). More patients on rivaroxaban had a level out-of-range (n = 10) than in-range (n = 4). One patient had a DVT, resulting in hospitalization and change in DOAC therapy. Two patients had bleeding events, with 1 hospitalization and change in DOAC therapy. DOAC level results also prompted changes in therapeutic plans for 9 of the patients. Conclusion: DOAC level results did not always correlate with expected outcomes, and further research is warranted to clarify which clinical situations may benefit from ordering DOAC levels.
摘要：
目的：描述血管医学诊所与临床结果相关的直接口服抗凝剂（DOAC）水平排序和解释实践。方法:本研究为回顾性研究,观察性研究包括在DOAC治疗期间对DOAC水平进行排序和评估的患者。主要结果是DOAC水平在先前报告的范围内的比例。次要结局包括血栓性事件,主要和临床相关的非主要出血事件，和DOAC水平结果的比例促使治疗计划的改变。结果：在DOAC治疗期间，共有43名DOAC水平的患者被纳入研究。服用阿哌沙班的患者比其他DOAC多，抗凝治疗最常见的指征是深静脉血栓形成（DVT）或肺栓塞（PE）。订购DOAC水平的最常见原因包括胃旁路术史（n=20）和药物-药物相互作用（n=8）。使用阿哌沙班的大多数患者与超范围水平（5名患者）相比具有范围内的水平（n=24）。服用利伐沙班的患者水平超出范围（n=10）比范围内（n=4）更多。一个病人有DVT,导致住院和DOAC治疗的改变。两名患者出现出血事件,1例住院和DOAC治疗的变化。DOAC水平结果也促使9名患者的治疗计划发生变化。结论：DOAC水平结果并不总是与预期结果相关，并且需要进一步的研究来澄清哪些临床情况可能受益于订购DOAC水平。
