Internal and Emergency Medicine

, Volume 13, Issue 7, pp 1093–1096 | Cite as

Drug plasma level measurement in management of severe bleeding during direct oral anticoagulant treatment: case report and perspective

  • Dimitriy Arioli
  • Davide DonelliEmail author
  • Lorenzo Morini
  • Maria Cristina Leone
  • Emanuele Alberto Negri

To the Editor,

The introduction of direct oral anticoagulants (DOACs) has changed the perspective about the patient’s needs in clinical practice. A complete understanding of their optimal management has yet to be achieved especially when dealing with critical patients.

Recently, a case has raised relevant questions about the correct management of patients presenting with severe bleeding during DOAC treatment. Starting from the learning points obtained from the case, we propose a possible algorithm to improve the care of patients presenting with severe bleeding during DOAC treatment. Before discussing, we report the case briefly.

A 65-year-old woman who was taking rivaroxaban 20 mg/day and acetylsalicylic acid 75 mg/day for ischaemic cardiomyopathy with persistent atrial fibrillation (AF) (CHA2DS2 VASC = 7), and recent history of ischemia in the upper limb, presented to the emergency department (ED) because of a syncope after 2 days of melaena. At admission, the patient (who suffered...


Direct oral anticoagulants Thrombosis Haemostasis Drug plasma levels Severe bleeding Management 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statements on human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© SIMI 2018

Authors and Affiliations

  1. 1.Medicina II Cardiovascolare, Department of Internal MedicineArcispedale Santa Maria Nuova - IRCCSReggio EmiliaItaly
  2. 2.Alta Intensità Medica, Department of Internal MedicineArcispedale Santa Maria Nuova - IRCCSReggio EmiliaItaly
  3. 3.Laureando CdLM Medicina e ChirurgiaUniversità di ParmaParmaItaly

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