Heparin Infusion Use & DOAC interference

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Thu, 06/18/2026 - 16:56
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Laura Frantz
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Heparin Infusion Use & DOAC interference

Good afternoon,
Our health system is re-evaluating our DOAC to heparin infusion transition workflow. We currently check an anti-Xa level when infusion protocol is initially ordered, and if elevated, our pharmacy is allowed to automatically convert our nurse driven anti-Xa protocol to the appropriate Low or High PTT protocol until DOAC effects on anti-Xa monitoring abate. Our regional physician lab directors are recommending against continued use of heparin dosed by PTT for patients with recent DOAC due to insufficient evidence to support that measured PTT levels are accurate in this population. Would anyone be able to describe or share your transition workflow and the protocol that your site or health system uses in this scenario? Feel free to replay all or message me directly at lrfrantz@novanthealth.org.

Thank you!
Laura Frantz, PharmD, BCPS, DPLA
Medication Safety Specialist
Novant Health, Inc
Charlotte, NC

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