Initial individual ROTEM for liver transplant recipients on DOAC. (A) Patient 1 had normal CT, indicating normal extrinsic pathway factors and no discernable DOAC effect, and relatively normal MCF, indicating adequate clot strength. (B) Patient 3 had prolonged CT, indicating inhibited extrinsic pathway factors and DOAC effect, and elevated MCF, indicating enhanced hemostatic reserve from platelet and fibrin contribution. (C) Patient 4 had prolonged CT, indicating inhibited extrinsic pathway factors and DOAC effect, and reduced MCF, indicating reduced clot firmness based on platelet and fibrin contribution. | 1683LIVER TRANSPLANTATION reversal agent during or after their operation. Given the small number of patients reviewed, we are unable to establish a direct cause and effect relationship between perioperative DOAC use and bleeding. In addition, it is important to note the relatively low laboratory MELD scores in our case series, which may impact the generalizability of our findings. However, this report provides evidence of the possibility to perform DDLT safely without reversal prior to surgery.