Plasma levels of direct oral anticoagulants in real life @entity1 with XXXX : Results observed in four anticoagulation clinics.

@entity1 @entity35105 @entity3926 @entity3925 @entity5424 @entity955 @entity1011 @entity6236
INTRODUCTION: Direct oral anticoagulant (DOAC) intra- and inter-individual variability was previously reported, but its magnitude is still considered negligible for @entity1 management. OBJECTIVE: To evaluate inter- and intra-individual variability in real-world @entity955 @entity1 on @entity3926 , @entity3925 or @entity5424 in four Italian anticoagulation clinics and to assess the correlation between DOAC plasma concentration and @entity1011 -clearance ( @entity35105 ). MATERIALS AND METHODS: A total of 330 consecutive @entity1 were enrolled, of which 160 were on @entity3926 (70 and 90 taking 150mg or 110mg twice-daily, respectively), 71 on @entity3925 (37 and 34 taking 20mg or 15mg once-daily) and 99 on @entity5424 (73 and 26 taking 5mg or 2.5mg twice-daily). Blood was taken at trough and peak within the first month (15-25days) of treatment. Diluted-thrombin-time (dTT) calibrated for @entity3926 and anti- @entity6236 calibrated for @entity3925 or @entity5424 was performed. RESULTS: Mean inter-individual variability expressed as overall CV values for all drugs was lower at peak (CV=46%) than at trough (CV=63%). Mean CV% intra-individual variability was 36.6% at trough and 34.0% at peak. Correlation with @entity35105 was poor for all drugs and only @entity3926 at trough showed a significant correlation. CONCLUSION: This multicenter study confirms high DOAC inter-individual variability that cannot be explained by the rate of renal clearance to which the three DOAC were subjected since the correlation with @entity35105 was relatively poor. This poor correlation suggests caution in using @entity35105 as the sole laboratory parameter to indirectly evaluate residual circulating DOAC.
