Standardized DOAC Interruption Protocols Result in Low Residual Levels, but Apixaban and Renal Impairment Merit Closer Monitoring

MedXY Editorial Team•Feb 5, 2026•Cardiology

The DALI study found that 7.6% of patients following standardized interruption protocols had residual direct oral anticoagulant (DOAC) levels of 30 ng/mL or higher at the time of elective surgery.
Patients treated with apixaban were significantly more likely to have elevated preprocedural levels (13.1%) compared to those on rivaroxaban or dabigatran.
Decreased kidney function and shorter interruption times were identified as key independent factors associated with higher residual DOAC concentrations.
Crucially, preoperative DOAC levels were not associated with surgical blood loss, and all major bleeding events occurred in patients with levels below 30 ng/mL.

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This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

The DALI study found that 7.6% of patients following standardized interruption protocols had residual direct oral anticoagulant (DOAC) levels of 30 ng/mL or higher at the time of elective surgery.
Patients treated with apixaban were significantly more likely to have elevated preprocedural levels (13.1%) compared to those on rivaroxaban or dabigatran.
Decreased kidney function and shorter interruption times were identified as key independent factors associated with higher residual DOAC concentrations.
Crucially, preoperative DOAC levels were not associated with surgical blood loss, and all major bleeding events occurred in patients with levels below 30 ng/mL.