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Coagulation Testing in Patients Taking Direct Oral AnticoagulantsA Teachable Moment

Educational Objective
To describe appropriate measures of therapeutic anticoagulation in patients taking direct oral anticoagulants (DOACs).
1 Credit CME

A 55-year-old man with a history of atrial fibrillation, hypertension, and type 2 diabetes mellitus presented to the emergency department (ED) with abdominal pain and vomiting for 1 day after eating leftover salad. His medications included rivaroxaban, amlodipine, and metformin. Results from physical examination were unremarkable. The patient’s comprehensive metabolic panel and complete blood cell count revealed no significant abnormalities. Abdominal radiograph to rule out small bowel obstruction was within normal limits. The patient received 2 L of normal saline with resultant symptomatic improvement. The diagnosis of gastroenteritis was made with plans to discharge the patient.

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Article Information

Corresponding Author: Sung-hee Choi, MD, Division of Hematology Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8852 (sung-hee.choi@utsouthwestern.edu).

Published Online: June 24, 2019. doi:10.1001/jamainternmed.2019.1799

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

Additional Information: During preparation and submission of this manuscript, Dr Siddiq was a third-year internal medicine resident.

References
1.
Henry J Kaiser Family Foundation. Hospital Adjusted Expenses Per Inpatient Day. https://www.kff.org/health-costs/state-indicator/expenses-per-inpatient-day/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed February 17, 2019.
2.
Turkoglu  EI.  NOACs and routine coagulation assays: how to interpret?  Int J Cardiovasc Acad.2015;1(2-3):41-42. doi:10.1016/j.ijcac.2015.10.004Google ScholarCrossref
3.
Ofek  F, Bar Chaim  S, Kronenfeld  N, Ziv-Baran  T, Berkovitch  M.  International normalized ratio is significantly elevated with rivaroxaban and apixaban drug therapies: a retrospective study.  Clin Ther. 2017;39(5):1003-1010. doi:10.1016/j.clinthera.2017.04.007PubMedGoogle ScholarCrossref
4.
Ciurus  T, Sobczak  S, Cichocka-Radwan  A, Malgorzata  L.  New oral anticoagulants—a practical guide.  Polish J Thorac Cardiovasc Surg. 2015;12(2):111-118. doi:10.5114/kitp.2015.52851Google ScholarCrossref
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