Table 1. Patient demographics, reason for sending DOAC level, and results of DOAC testing.
Patient | Reason for testing | Age (years) | Gender M=male, F= female | BMI (kg/m2) | Weight (kg) | Dose (QD= daily, BID=twice daily) | DOAC level (ng/ml)* | Peak vs trough | Miscellaneous Notes | Outcome |
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Apixaban | ||||||||||
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1 | obesity | 64 | F | 50.7 | 139.8 | 5 mg BID | 240.3 | peak | no change | |
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2 | obesity | 41 | F | 66.8 | 199.1 | 5 mg BID | 110.6 | peak | no change | |
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3 | low body weight | 88 | F | 22.6 | 54.3 | 2.5 mg BID | 102 | trough | no change | |
218.5 | peak | |||||||||
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4 | recurrent TTP with stroke on apixaban | 45 | F | 34.5 | 82.8 | 5 mg BID | 229.5 | peak | inpatient | stopped apixaban, resumed aspirin |
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5 | Livedoid vasculopathy with persistent symptoms in spite of a/c | 66 | M | 28.1 | 90.2 | 5 mg BID | 93.3 | random | 8 hour post dose | no change |
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6 | healing leg ulcer with palpable clotted veins around it | 28 | M | 27.3 | 86.2 | 5 mg BID | 159 | peak | 4 hours post dose | no acute thrombus, no change to dose |
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7 | progressive superior mesenteric vein thrombosis in spite of apixaban | 62 | F | 46.2 | - | 7.5 mg BID | 274 | peak | inpatient; 4 hour post dose | switched to LMWH in setting of malignancy |
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8 | unclear | 70 | F | 27.4 | 70.2 | 5 mg BID | 269.2 | trough | no change | |
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Rivaroxaban | ||||||||||
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9 | obesity | 27 | M | 56.2 | 203.9 | 15 mg BID | 0 | trough | 17 hours post-dose | no change |
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10 | obesity | 40 | M | 43.6 | - | 20 mg QD | 222.3 | peak | 3 hours post-dose | no change |
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11 | obesity | 47 | M | 40.7 | 150 | 20 mg QD | 15.5 | trough | no change | |
205.6 | peak | 2.5 hours post-dose | ||||||||
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12 | obesity | 33 | F | 51.2 | 148.3 | 20 mg QD | 96.5 | random | no change | |
37.8 | trough | |||||||||
459.8 | peak | |||||||||
| ||||||||||
13 | obesity | 43 | M | 44.9 | 158.8 | 20 mg QD | 142.4 | peak | no change | |
17 | trough | |||||||||
134 | random | no change | ||||||||
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14 | obesity | 47 | F | 59.3 | 161.6 | 20 mg QD | 139.1 | random | no documentation | no change |
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15 | obesity | 47 | F | 50.1 | 140.6 | 20 mg QD | 0 | trough | 24 hours | no change |
123.7 | peak | 2.5 hours post-dose | ||||||||
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16 | low body weight | 30 | F | 20 | 44.5 | 15 mg QD | 155.5 | peak | no change | |
5.8 | peak | no change | ||||||||
116 | peak | no change | ||||||||
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17 | concern for new thrombus, rule out anticoagulation failure | 38 | M | 26.6 | 96.5 | 15 mg BID | 161.6 | peak | determined thrombus developed prior to rivaroxaban inittiation; thus no change | |
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18 | history of supratherapeutic INR on warfarin, concern for overdosing of rivaroxaban | 29 | F | 22.8 | 60.1 | 20 mg QD | 19.4 | random | no change | |
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19 | history of bleeding at lower dose | 54 | F | NR | NR | 20 mg QD | 282.6 | peak | 3 hours post-dose | no change |
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20 | starting terbinafine- concern for medication interaction | 53 | M | 31.6 | 103.4 | 20 mg QD | 250.3 | peak | no change | |
post-terbinafine dose | 210.1 | peak | level checked one week after starting terbinafine | no change | ||||||
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21 | post gastric bypass | 60 | F | 30.9 | 100.4 | 20 mg QD | 125.8 | peak | 4 hours post-dose | no change |
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22 | s/p bowel resection | 21 | M | 30.9 | 106.2 | 20 mg QD | 0 | random | no change | |
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23 | unclear | 70 | M | 27.6 | 87.3 | 20 mg QD | 194 | peak | 4 hours after last dose | no change |
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Dabigatran | ||||||||||
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24 | acute on chronic renal failure, need for line placement | 59 | M | 37.6 | NR | 150 mg QD | 194 | random | 7d after last dose | monitored level until renal biopsy performed without complication |
155 | random | 8d post-dose | ||||||||
128 | random | 9d post-dose | ||||||||
117 | random | 10d post-dose | ||||||||
88 | random | 11d post-dose | ||||||||
66 | random | 12d post-dose | ||||||||
66 | random | 13d post-dose | ||||||||
44 | random | 15d post-dose | ||||||||
54 | random | 16.5d post-dose | ||||||||
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25 | need for urgent surgical intervention | 75 | M | 25.2 | NR | NR | 91.72 | random | 24 hours post-dose | levels monitored in preparation for surgery; ultimately never underwent surgery |
65 | random | 48 hours post-dose | ||||||||
46.1 | random | 7d post-dose | ||||||||
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26 | pre-op | 65 | F | 14.9 | 81.6 | 150 mg BID | <30 | random | 24 hours post-dose | repair of wound dehiscience of deep brain stimulator |
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27 | APLAS | 21 | F | 21.9 | NR | 150 mg BID | 85.11 | peak | 1 hour post-dose | no change |
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28 | prolonged PT/PTT | 59 | F | NR | 108 | 150 mg BID | 92 | random | dabigatran held in setting of prolonged PTT/PT due to liver synthetic dysfunction |
Determined by liquid chromatography- mass spectrometry (LC-MS) and reported as anti-Xa drug level for apixaban and rivaroxaban and by chromogenic ecarin assay for dabigatran
Abbreviations: BMI= body mass index; INR= international normalized ratio; APLAS = anti-phospholipid antibody syndrome; PT= prothrombin time; PTT= partial thromboplastin time; d=days, hrs= hours