{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T22:58:34Z","timestamp":1773701914274,"version":"3.50.1"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009448","name":"Universit\u00e0 degli Studi della Campania Luigi Vanvitelli","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009448","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Drugs Ther"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The withdrawal timing of direct oral anticoagulants (DOACs) among patients in need of elective invasive surgery is based on DOAC pharmacokinetics in order to perform the procedure out of the DOAC peak plasma concentration. We aimed to investigate the prevalence and predictors of plasma levels of DOACs out of trough range in patients with atrial fibrillation (AF) in need of elective cardiac procedure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Materials and Methods<\/jats:title>\n            <jats:p>We evaluated all consecutive AF patients on DOAC therapy in need of elective cardiac procedure, admitted to our division from January 2022 to March 2022. All patients underwent DOAC plasma dosing the morning of procedure day. They were categorized as in range, above range, and below range, according to the DOAC reference range at the downstream point. The timing of discontinuation of DOAC therapy was considered as appropriate or not, according to the current recommendations. The clinical predictors of out-of-range DOAC plasma levels have been evaluated.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>We included 90 consecutive AF patients (56.6% male, mean age 72.95\u2009\u00b1\u200910.12\u00a0years); 74 patients (82.22%) showed DOAC concentration out of the expected reference range. In half of them (<jats:italic>n<\/jats:italic>, 37), the DOAC plasma concentration was below the trough reference range. Of the study population, 17.7% received inappropriate DOAC dosages (10% overdosing, 7% underdosing), and 35.5% had incorrect timing of DOAC withdrawal (26% prolonged, 9.5% shortened). At multivariable analysis, inappropriate longer DOAC withdrawal period (OR 10.13; <jats:italic>P<\/jats:italic>\u2009\u2264\u20090.0001) and increased creatinine clearance (OR 1.01; <jats:italic>P<\/jats:italic>\u2009=\u2009<jats:italic>0.0095<\/jats:italic>) were the independent predictors of plasma DOAC levels below the therapeutic trough range. In contrast, diabetes mellitus (OR 4.57; <jats:italic>P<\/jats:italic>\u2009=\u2009<jats:italic>0.001<\/jats:italic>) was the only independent predictor of DOAC plasma level above the therapeutic trough range.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Increased creatinine clearance and inappropriate longer drug withdrawal period are the only independent predictors of DOAC plasma levels below the reference range; in contrast, diabetes is significantly correlated with DOAC plasma levels above the reference.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10557-024-07573-1","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T04:02:03Z","timestamp":1710907323000},"page":"775-781","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of Plasma Levels of Direct Oral Anticoagulants Among Patients with Atrial Fibrillation in Need of Elective Cardiac Procedures"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9227-0360","authenticated-orcid":false,"given":"Vincenzo","family":"Russo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleonora","family":"Caiazza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiorella Chiara Delle","family":"Femine","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrica","family":"Pezzullo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Sarpa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Ianniciello","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caturano","family":"Alfredo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonello","family":"D\u2019Andrea","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Golino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerardo","family":"Nigro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,3,20]]},"reference":[{"issue":"5","key":"7573_CR1","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","volume":"42","author":"G Hindricks","year":"2021","unstructured":"Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42(5):373\u2013498. https:\/\/doi.org\/10.1093\/eurheartj\/ehaa612.","journal-title":"Eur Heart J"},{"issue":"10","key":"7573_CR2","doi-asserted-by":"publisher","first-page":"1612","DOI":"10.1093\/europace\/euab065","volume":"23","author":"J Steffel","year":"2021","unstructured":"Steffel J, Collins R, Antz M, et al. 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. EP Europace. 2021;23(10):1612\u201376. https:\/\/doi.org\/10.1093\/europace\/euab065.","journal-title":"EP Europace"},{"issue":"06","key":"7573_CR3","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1160\/TH09-11-0758","volume":"103","author":"J van Ryn","year":"2010","unstructured":"van Ryn J, Stangier J, Haertter S, et al. Dabigatran etexilate \u2013 a novel, reversible, oral direct thrombin inhibitor: Interpretation of coagulation assays and reversal of anticoagulant activity. 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Semin Thromb Hemost. 2021;47(02):150\u201360. https:\/\/doi.org\/10.1055\/s-0041-1723770.","journal-title":"Semin Thromb Hemost"},{"issue":"18","key":"7573_CR8","doi-asserted-by":"publisher","first-page":"5955","DOI":"10.3390\/jcm12185955","volume":"12","author":"F Luc\u00e0","year":"2023","unstructured":"Luc\u00e0 F, Oliva F, Abrignani MG, et al. Management of patients treated with direct oral anticoagulants in clinical practice and challenging scenarios. J Clin Med. 2023;12(18):5955. https:\/\/doi.org\/10.3390\/jcm12185955.","journal-title":"J Clin Med"},{"issue":"3","key":"7573_CR9","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1097\/FJC.0000000000000786","volume":"75","author":"E Melillo","year":"2020","unstructured":"Melillo E, Carbone A, Rago A, et al. Update on direct oral anticoagulants in atrial fibrillation patients undergoing cardiac interventional procedures: from clinical trials to real-world evidence. 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Approval was granted by the Ethics Committees of Monaldi Hospital, Naples; University of Campania \u201cLuigi Vanvitelli,\u201d Naples.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}},{"value":"The authors declare no competing interests to disclose.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}]}}