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Research Snapshot Theater: Hematology, Adult II

Using Anti-Xa Concentrations to Guide Direct Oral Anticoagulant Transitions Upon ICU Admission

Monday, March 23, 2026
2:30 PM - 3:30 PM Central Time
Location: Connections Central - RST 04
Introduction: The increased utilization of oral factor Xa inhibitors (FXaI) has led to a growing interest in the clinical utility of FXaI-specific anti-Xa concentrations. Critically ill populations are at risk of bleeding secondary to FXaI accumulation in the setting of end-organ dysfunction. Although data remains limited in the critically ill, using anti-Xa concentrations to guide inpatient transitions from oral to parenteral anticoagulation could represent a risk-mitigating strategy. The primary objective of this study was to compare the incidence of bleeding upon intensive care unit (ICU) admission between two different FXaI transition strategies: concentration vs. non-concentration guided.


Methods: This was a retrospective cohort study of adult patients admitted between January 2019 and May 2022 with objective evidence of FXaI exposure within 48 hours preceding ICU admission. Patients were excluded if they were admitted to the ICU with a primary diagnosis related to a bleeding event, received a non-FXaI anticoagulant 48 hours preceding ICU admission, remained off anticoagulation during their ICU admission, or underwent surgical procedures. The primary outcome was the incidence of major bleeding within 5 days of ICU admission. Thromboembolic events were evaluated as a secondary endpoint.


Results: A total of 433 patients (184 concentration-guided versus 249 non-concentration-guided) were included. There was no difference in major bleeding between groups (2.7% in concentration-guided vs. 3.6% in non-concentration-guided; p=0.79). Thromboembolic complications were similar between groups (1.6% in concentration-guided vs. 2.0% in non-concentration guided; p=1.00) despite a longer time from last FXaI dose to anticoagulant transition in the concentration-guided group (29.9 hours vs. 19.4 hours; p< 0.01).


Conclusions: Use of FXaI concentrations to guide anticoagulation transition in the ICU had no impact on major bleeding events or thromboembolic complications. Further analyses are needed to validate FXaI concentration-guided strategies and solidify anti-Xa cutoffs to create a standardized approach to FXaI transitions in the critically ill patient population.