Feasibility issues, difficulties in the patient pathway, advances in knowledge

This is a prospective, multicentric, randomized, open labeled superiority trial

This study aims to evaluate the efficacy of oral activated charcoal for improving elimination of direct oral anticoagulants ( Rivaroxaban, Apixaban) in case of an unscheduled invasive procedure delayed to this anticoagulant treatment.

The primary outcome is the anticoagulant's half life. Plasma concentration will be measured by liquid chromatography-mass spectrometry for the main analysis (pharmacokinetic).

A total of 140 patients will randomly be assigned to the charcoal or control group, stratified according to their anticoagulant drug.

Inclusion Criteria:

• Patients under direct oral anticoagulant treatment (Apixaban, Rivaroxaban or Dabigatran)
• Age ≥18 years;
• Clinical condition needing a surgery or invasive procedure ( lumbar puncture, biopsy...), needing anticoagulant treatment interruption and intervention to be postponed
• Signed informed consent

Exclusion Criteria:

• Urgent immediate surgery without any possibility to wait for 24 hours
• contraindication for receiving oral treatment
• Active uncontrolled bleeding or bleeding in critical organ
• Hemodynamic instability, shock
• Known anticoagulant concentration < 50ng/mL
• drug intoxication
• Fructose intolerance, glucose and galactose malabsorption syndrome, sucrase-isomaltase deficit
• Treated epileptic disease
• Pregnant or breast feeding
• Patient under guardianship
• No insurance cover
• Patient unable to give his consent
• Participation to another therapeutic trial