We investigated in-vitro the management of intraprocedural anticoagulation in patients requiring immediate percutaneous coronary intervention(PCI) while using regular direct oral anticoagulants(DOACs). Twenty-five patients taking 20mg of rivaroxaban once daily comprised the study group, while five healthy volunteers included the control group. In study group, a beginning(24-hours after the last rivaroxaban dose) examination was performed. Then, the effects of basal and four different anticoagulant doses(50IU/kg unfractionated heparin(UFH), 100IU/kg UFH, 0.5mg/kg enoxaparin, and 1mg/kg enoxaparin) on coagulation parameters were investigated at the 4th and 12th hours following rivaroxaban intake. Anticoagulant activity was assessed mainly by anti-factor Xa(anti-Xa) levels.

Inclusion Criteria:

• patients using the direct oral factor Xa inhibitor rivaroxaban
• Atrial fibrillation

Exclusion Criteria:

• malignancy,
• coagulopathy,
• heart valve disease,
• active infection,
• chronic systemic or inflammatory disease,
• recent ACS or elective PCI,
• uncontrolled hypertension and diabetes,
• cerebrovascular accident,
• thyroid disorder,
• left ventricular systolic dysfunction (ejection fraction <50%),
• glomerular filtration rate <50 mL/min/1.73 m2,
• underweight and overweight (<60 kg and >100 kg),
• age >75 years,
• hyperbilirubinemia and hypertriglyceridemia (>350 mg/dl).

patients with persistent or permanent AF had been using rivaroxaban 20 mg daily for at least one month