50
Management
Figure 11. DOAC Laboratory Monitoring
C
rC
L
>6
0
m
L
/
m
in
C
rC
L
3
0
–59
m
L
/
m
in
C
rC
L
<3
0
m
L
/
m
in
Severe
liver
disease
(C
h
ild-
Pu
gh
C)
Moderate
liver
disease
(C
h
ild-
Pu
gh
B)
Mild
liver
disease
(C
h
ild-
Pu
gh
A)
No
liver
disease
Low
or
moderate
blee
ding
risk
(HAS-B
LED
score
0
–2)
DOAC
laboratory
monitorin
g
para
meters
Hemoglobin/
hematocrit*
Renal
function
High bleeding risk
(HAS-BLED score
≥3)
CrCL indicates creatinine clearance based on actual body weight; INR, international
normalized ratio. Developed by Atrial Fibrillation Guideline Writing Committee. 2022.
* HAS-BLED scoring (low risk=score 0, moderate risk=score 1–2, high risk=score ≥3):
uncontrolled hypertension (systolic blood pressure >160 mm Hg )=1 point; abnormal renal
(serum creatinine >2.26 mg/dL, dialysis, or kidney transplant) or hepatic function (bilirubin
>2 times upper limit normal, alanine aminotransferase/aspartate aminotransferase/alkaline
phosphatase >3 times upper limit normal, or cirrhosis)=1 or 2 points; stroke (hemorrhagic or
ischemic)=1 point; bleeding history or predisposition=1 point; labile INR (time in therapeutic
range <60%)=1 point; elderly age >65 years=1 point; drugs (antiplatelet agents or nonsteroidal
anti-inflammatory drugs) or excessive alcohol intake (8 units/week)=1 or 2 points.
Child-Pugh scoring : the severity of liver disease, primarily cirrhosis in patients with
documented liver disease. Child-Pugh A (mild): 5 to 6 points; Child-Pugh B (moderate):
7 to 9 points; Child-Pugh C (severe): 10 to 15 points. e score is based on the 5 variables:
encephalopathy (none=1 point, grade 1 and 2=2 points, grade 3 and 4=3 points); ascites
(none=1 point, slight=2 points, moderate=3 points); total bilirubin (<2 mg/mL=1 point, 2–3
mg/mL=2 points, >3 mg/mL=3 points); albumin (>3.5 mg/mL=1 point, 2.8–3.5 mg/mL=2
points, <2.8 mg/mL=3 points); INR (<1.7=1 point, 1.7–2.2=2 points, >2.2=3 points).
Liver
function
†
