Management of bleeding and non-elective invasive procedures in patients receiving direct oral anticoagulants (DOAC): a five-year single center observational study
Abstract
Background Guidelines exist for managing bleeding or non-elective invasive procedures in patients on direct oral anticoagulants (DOAC), but their clinical impact remains unclear. This study described the management of patients who had DOAC concentrations measured for bleeding or non-elective invasive procedures and assessed associations between guideline compliance, outcomes, and DOAC concentrations. Methods This retrospective, single-center study (2014–2018) included adult patients receiving dabigatran etexilate, rivaroxaban, or apixaban who required hospital care for bleeding or non-elective invasive procedures and had DOAC concentrations measured at the time of the event. Compliance with French and European guidelines was assessed. Adverse outcomes—a composite of all-cause mortality, worsening or new bleeding, and thrombotic events—were recorded until discharge. Results A total of 584 events (432 procedures, 152 bleeding episodes) in 547 patients were analyzed. Guideline compliance was 79% and showed no association with outcomes. Among 95 events treated with prothrombin complex concentrates, one thrombotic event occurred. DOAC concentrations were higher in bleeding than in procedural group (122 [57–219] vs 55 [25–127] ng.mL -1 ), but bleeding severity was not associated with drug levels. In bleeding patients, rivaroxaban concentrations were higher in those with adverse outcomes compared to those without (243 [74–367] vs 88 [35–199] ng.mL -1 ). Conclusion In a large cohort of patients who had DOAC concentrations measured at the time of a bleeding or a non-elective invasive procedure, compliance with guidelines was high and not associated with outcomes. In bleeding patients, rivaroxaban concentrations were higher in those with vs without adverse events.
Related
- Management of bleeding and nonelective invasive procedures in patients receiving direct oral anticoagulants (DOACs): a 5-year single-center observational study
- CO038 | PROGNOSTIC PERFORMANCE OF BLEEDING SEVERITY CLASSIFICATIONS IN HOSPITALIZED PATIENTS WITH GASTROINTESTINAL BLEEDING ON DIRECT ORAL ANTICOAGULANTS
- Integrating pharmacovigilance and machine learning: bleeding signal detection and risk prediction for oral anticoagulants in cancer patients
- A Model for Estimating the Risk of Gastrointestinal Bleeding for Patients on Oral Anticoagulants and Interacting Medications.
- Prognostic value of scoring systems in geriatric patients receiving warfarin presenting with upper gastrointestinal bleeding
BibTeX
@article{pontis2026management,
title = {{Management of bleeding and non-elective invasive procedures in patients receiving direct oral anticoagulants (DOAC): a five-year single center observational study}},
author = {Adeline Pontis and Alexandre Mansour and Axelle Maurice and Chloé Rousseau and Fabienne Nédelec-Gac and Pierre Guéret and Louis Soulat and Laure Maucorps and Anne Godier and Isabelle Gouin-Thibault},
journal = {Research and Practice in Thrombosis and Haemostasis},
year = {2026},
month = oct,
doi = {10.1016/j.rpth.2026.107003},
url = {https://hal.science/hal-05780285v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Management of bleeding and non-elective invasive procedures in patients receiving direct oral anticoagulants (DOAC): a five-year single center observational study
AU - Adeline Pontis
AU - Alexandre Mansour
AU - Axelle Maurice
AU - Chloé Rousseau
AU - Fabienne Nédelec-Gac
AU - Pierre Guéret
AU - Louis Soulat
AU - Laure Maucorps
AU - Anne Godier
AU - Isabelle Gouin-Thibault
PY - 2026
DA - 2026/10/01
JO - Research and Practice in Thrombosis and Haemostasis
DO - 10.1016/j.rpth.2026.107003
UR - https://hal.science/hal-05780285v1
AB - Background Guidelines exist for managing bleeding or non-elective invasive procedures in patients on direct oral anticoagulants (DOAC), but their clinical impact remains unclear. This study described the management of patients who had DOAC concentrations measured for bleeding or non-elective invasive procedures and assessed associations between guideline compliance, outcomes, and DOAC concentrations. Methods This retrospective, single-center study (2014–2018) included adult patients receiving dabigatran etexilate, rivaroxaban, or apixaban who required hospital care for bleeding or non-elective invasive procedures and had DOAC concentrations measured at the time of the event. Compliance with French and European guidelines was assessed. Adverse outcomes—a composite of all-cause mortality, worsening or new bleeding, and thrombotic events—were recorded until discharge. Results A total of 584 events (432 procedures, 152 bleeding episodes) in 547 patients were analyzed. Guideline compliance was 79% and showed no association with outcomes. Among 95 events treated with prothrombin complex concentrates, one thrombotic event occurred. DOAC concentrations were higher in bleeding than in procedural group (122 [57–219] vs 55 [25–127] ng.mL -1 ), but bleeding severity was not associated with drug levels. In bleeding patients, rivaroxaban concentrations were higher in those with adverse outcomes compared to those without (243 [74–367] vs 88 [35–199] ng.mL -1 ). Conclusion In a large cohort of patients who had DOAC concentrations measured at the time of a bleeding or a non-elective invasive procedure, compliance with guidelines was high and not associated with outcomes. In bleeding patients, rivaroxaban concentrations were higher in those with vs without adverse events.
SN - 2475-0379
SN - 2475-0379
ER -