|Exclude Clinically Relevant∗ Drug Levels||Determine Whether On-Therapy or Above On-Therapy Levels Are Present|
|Suggested Test||Interpretation||Suggested Test||Interpretation|
|Apixaban||UFH or LMWH anti-FXa||PT|
|Betrixaban, edoxaban, or rivaroxaban||UFH or LMWH anti-FXa||PT|
aPTT = activated partial thromboplastin time; DOAC = direct-acting oral anticoagulant; FXa= factor Xa; LMWH = low-molecular-weight heparin; PT = prothrombin time; TT = thrombin time; UFH = unfractionated heparin.
↵∗ The term “clinically relevant” refers to DOAC levels that may contribute to bleeding or surgical bleeding risk. The minimum DOAC level that may contribute to bleeding or surgical bleeding risk is unknown. The International Society on Thrombosis and Hemostasis recommends consideration of anticoagulant reversal for patients with serious bleeding and a DOAC level >50 ng/mL, and for patients requiring an invasive procedure with high bleeding risk and a DOAC level >30 ng/mL (10).