Dielectric blood coagulometry to evaluate coagulation activity in patients prescribed factor Xa inhibitors undergoing elective surgery: A prospective observational study.

Summary

In a perioperative cohort, DBCM coagulation time correlated strongly with apixaban and rivaroxaban plasma concentrations (Rs=0.87 and 0.91) and inversely with peak thrombin generation, achieving AUC 0.98–0.99 to identify samples <30 ng/mL. Findings support DBCM as a promising point-of-care tool to assess residual DOAC effect before anesthesia/surgery.

Key Findings

• DBCM coagulation time strongly correlated with apixaban (Rs=0.87, n=57) and rivaroxaban (Rs=0.91, n=49) plasma concentrations.
• DBCM coagulation time inversely correlated with peak thrombin generation (apixaban Rs=-0.80; rivaroxaban Rs=-0.84).
• AUC for identifying samples with <30 ng/mL DOAC: 0.98 (apixaban) and 0.99 (rivaroxaban).

Clinical Implications

DBCM could enable bedside assessment of residual factor Xa inhibitor effect to streamline OR scheduling, reduce unnecessary delays or bridging, and enhance safety for neuraxial procedures; multicenter validation and outcome studies are the logical next steps.

Limitations

• Single-setting study with modest sample sizes limited to apixaban and rivaroxaban; generalizability to other DOACs (e.g., edoxaban) unknown.
• Clinical management outcomes (e.g., bleeding/thrombotic events) based on DBCM-guided decisions were not assessed.

Future Directions

Multicenter validation including additional DOACs, establishment of perioperative decision algorithms incorporating DBCM, and randomized studies testing DBCM-guided management on clinical outcomes.