PB0136 - Impact of plasma monitoring of direct oral anticoagulants (DOACs) on therapeutic management. Real-life experience in a University Hospital from Argentina.

Sunday, June 23, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

VW

Valeria Wiersba Burgueño

Hematologist and Internal Medicine MD
Instituto Cardiovascular de Buenos Aires
Ciudad Autónoma de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina

Presenting Author(s)

CR

Claudio M. Rosa

Thrombosis and Haemostasis biochemist coordinator
Hospital Universitario Austral
Mercedes, Buenos Aires, Argentina

Co-Author(s)

MA

María Esther Aris Cancela

Hemostasia y Trombosis
Hospital Universitario Austral
Buenos Aires, Buenos Aires, Argentina
PC

Paulo Colimodio

Hematologist
Hospital Universitario Austral
Pilar, Buenos Aires, Argentina
AD

Agostina De Lorenzi

Hematologist
Hospital Universitario Austral
Pilar, Buenos Aires, Argentina
LB

Luzia Bolzico

Hematologist Resident
Hospital Universitario Austral
Pilar, Buenos Aires, Argentina
Jose M. Bonorino

Coronary Care Unit Medical Coordinator
HOSPITAL UNIVERSITARIO AUSTRAL
BELLA VISTA, BUENOS AIRES, Buenos Aires, Argentina
SM

Sonia Mereles

Laboratorio
Hospital Universitario Austral
Pilar, Buenos Aires, Argentina
MR

Maria Rigacci

Laboratorio
Hospital Universitario Austral
San Antonio de Areco, Buenos Aires, Argentina
CS

Carla Santilli

Biochemist
Hospital Universitario Austral
Pilar, Buenos Aires, Argentina
DC

Diego Colimodio

Laboratorio
Hospital Universitario Austral
Mercedes, Buenos Aires, Argentina

Background: The advent of DOACs marked a fundamental pharmacological milestone in the treatment and prevention of arterial and venous thrombotic events.
Despite their advantages, they exhibit intra and interpersonal variability in plasma concentration.
Consequently, despite the lack of randomized controlled studies linked to definitive therapeutic ranges and the uncertain impact on the safety and efficacy of monitoring, those results contribute to decision-making in daily real-life scenarios. Conditions such as extreme weight, kidney failure, pharmacological interactions, gastrointestinal surgeries, as well as urgent surgeries, major bleeding and off-label use in heparin-induced thrombocytopenia, represent some of these clinical situations.

Aims: The aim of this study is to evaluate if the results of plasma measurements of apixaban and rivaroxaban influence the decision-making and impact on treatment approach undertaken by hematologists. Additionally, the reasons for requesting monitoring and the complications will be assessed

Methods: This is a retrospective cohort study. DOACs’ plasma measurements made in Hospital Austral between January 2022 and June 2023 were included.

Results: A total of 175 assays were conducted. Measurements were excluded when information from medical records was insufficient to answer the necessary questions for data analysis, leaving a final count of 64 peaks, 72 troughs, and 7 random assays (urgent invasive procedures and major bleeding) in 75 patients anticoagulated mainly for venous thromboembolism and atrial fibrillation.
Treatment was modified in 16 patients after the monitoring, and only 12 based on the measurement’ results.
None of the hemorrhagic or thrombotic complication was related to measurements outside the specified ranges.

Conclusion(s): The present study failed to demonstrate a statistically significant impact of DOACs monitoring on clinical outcomes (bleeding or hemorrhage) or a change in the therapeutic approach undertaken by hematologists. However, the reassurance of safety concerning the appropriate dose justifies its implementation in certain clinical scenarios where a greater inter and intra-personal variability of drugs is known.