Case Report | DOI: https://doi.org/10.31579/2690-4861/1117
1 Thrombosis Expertise Center (TEC), Maastricht University Medical Center+, Maastricht, the Netherlands.
2 Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
3 Central Diagnostic Laboratory, Department of Clinical Chemistry and Hematology, Maastricht University Medical Center+, Maastricht, the Netherlands.
4 Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
*Corresponding Author: Daan Teerds, BSc Faculty of Health, Medicine and Life Sciences, CARIM P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
Citation: Daan Teerds, Irme S Franssen, Dionne CW Braeken, Dave Hellenbrand, Yvonne Henskens, (2026), Intra-Individual Variability of Direct oral Anticoagulant Plasma Concentrations in Frail Nursing-Home Residents, International Journal of Clinical Case Reports and Reviews, 36(3); DOI: 10.31579/2690-4861/1117
Copyright: © 2026, Daan Teerds. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 15 May 2026 | Accepted: 26 June 2026 | Published: 06 July 2026
Keywords: direct oral anticoagulants; nursing-home residents; frailty; pharmacokinetics; therapeutic drug monitoring; atrial fibrillation; polypharmacy
Direct oral anticoagulants are generally prescribed without routine laboratory monitoring, but exposure may be less predictable in frail nursing-home residents. This case series describes intra-individual variability in serial peak direct oral anticoagulant plasma concentrations in four frail nursing-home residents with atrial fibrillation, each treated with a different direct oral anticoagulant. Peak concentrations were measured 2 – 4 hours after dosing during routine nursing-home blood testing and interpreted against expected on-therapy ranges. Across 23 peak concentrations, 10 measurements (43%) were outside the expected range, with nine above and one below. Coefficients of variation ranged from 15.3% to 61.0%. Changes in estimated glomerular filtration rate or other clinical characteristics did not consistently explain the observed variability. These findings suggest that direct oral anticoagulant exposure in frail nursing-home residents may be clinically variable and support further prospective evaluation of selective concentration assessment and dose adjustment strategies.
AF: atrial fibrillation; CDL: Central Diagnostic Laboratory; CV: coefficient of variation; DOAC: direct oral anticoagulant; eGFR: estimated glomerular filtration rate; EPR: electronic patient record; INR: International Normalized Ratio; P-gp: P-glycoprotein; VKA: vitamin K antagonist; VTE: venous thromboembolism.
Direct oral anticoagulants (DOACs) have largely replaced vitamin K antagonists (VKAs) for thrombosis prevention in patients with atrial fibrillation (AF) and for the treatment and prevention of venous thromboembolism (VTE) [1-3]. Unlike VKAs, which require frequent International Normalized Ratio (INR) monitoring, DOACs have more predictable pharmacokinetic and pharmacodynamic profiles, allowing fixed dosing without routine laboratory testing [3].
However, frail older adults, particularly those living in nursing homes, are often underrepresented in pivotal clinical trials of DOACs [4-7]. This population is characterized by multimorbidity, polypharmacy (including the use of CYP3A4 and P-glycoprotein (P-gp) modulators), altered body composition and fluctuating renal function, all of which can influence drug exposure and may also affect DOAC plasma concentrations (hereafter, DOAC concentrations) [8-11]. As a result, DOAC pharmacokinetics may be less predictable in this group, raising concerns about the reliability of standardized dosing recommendations.
Intra-individual variability in DOAC concentrations remains poorly characterised, in part because routine laboratory monitoring is not recommended in current practice [3]. Available longitudinal studies in general cohorts suggest that intra-individual variability is often modest, but these data largely do not include frail nursing-home residents [12, 13]. In contrast, a study in acutely hospitalised frail older adults reported substantial intra-individual variability in DOAC concentrations [14], but whether similar patterns occur in long-term institutional care remains uncertain. Accordingly, the aim of this case series was to describe intra-individual variability in serial peak DOAC concentrations in four frail nursing-home residents with atrial fibrillation, each treated with a different DOAC, and to explore whether observed variability could be explained by renal function, documented intercurrent clinical changes, or strong CYP3A4/P-gp inhibitors or inducers.
Within the DOAC-FRAIL study, nursing-home residents receiving a DOAC were prospectively enrolled. Serial DOAC concentrations were collected during routine care to characterise intra- and inter-individual variability. For this case series, a descriptive analysis was performed on serial peak DOAC concentrations from four residents, each using a different type of DOAC.
One resident for each DOAC type was selected a priori using predefined, outcome-independent rules. Within each DOAC type, residents with ≥2 peak DOAC concentrations on different dates were first identified to permit estimation of intra-individual variability. From these, the resident with the greatest number of repeated peak DOAC concentrations was selected. If counts were equal, tie-breakers were applied in the following order: (i) data completeness, defined as availability of dosing and sampling times for all DOAC concentrations and non-missing key clinical variables (serum creatinine, eGFR, intercurrent illness and medication changes) across the sampling interval. Thereafter, (ii) the case that reached its highest number of measurements earlier in calendar time.
All residents lived in nursing homes with standardised care, including fixed medication times, nurse-supervised administration and consistent daily routines. Blood was drawn two to four hours post-dose (peak DOAC concentrations) alongside routine tests. Blood sampling occurred as part of routine nursing-home blood testing or during evaluation of intercurrent illness or clinical instability. The clinical indication for each routine blood draw was extracted from the medical record where documented. Assays were performed in the Central Diagnostic Laboratory (CDL) of the Maastricht University Medical Centre+ (MUMC+) using validated, drug-specific methods [15]. Factor Xa inhibitors (apixaban, edoxaban and rivaroxaban) were measured using a chromogenic anti-factor Xa assay, and dabigatran concentrations were measured using diluted thrombin time (Hemoclot) [15].
Clinical data were extracted from the electronic patient record (EPR). To evaluate intra-individual variability, coefficients of variation (CV) for peak DOAC concentrations were calculated. In line with previously reported intra-individual CVs for DOAC concentrations, values around 15 – 35% are often observed in general cohorts [13, 14, 16]. In this context, CVs above this upper bound were interpreted as indicating pronounced intra-individual variability. Peak DOAC concentrations were interpreted against the expected on-therapy ranges for AF reported by Douxfils et al. [17], given that AF was the indication for DOAC therapy in all four cases.
The DOAC-FRAIL study was approved by the Medical Ethics Review Committee azM/UM (METC 2021-2945-A-2) and written informed consent was obtained from all participants or their legal representatives.
Across 23 peak DOAC concentrations obtained under standardised nursing-home conditions, 10 out of 23 measurements (43.0%) fell outside the expected on-therapy range (9 above and 1 below). Figure 1 provides a longitudinal overview of serial peak DOAC concentrations and corresponding eGFR values for each case. In each panel, the DOAC concentration is plotted against the expected on-therapy peak range for atrial fibrillation, allowing visual assessment of whether repeated measurements remained within, above, or below the expected range over time.
A woman in her early 90s (58 kg) with AF received apixaban 5 mg twice daily. After the eighth measurement, the dose was reduced to 2.5 mg twice daily in accordance with dose-reduction criteria. In total, ten peak DOAC concentrations were collected between 9 July 2024 and 15 May 2025. Most routine blood draws were performed for periodic monitoring of renal function and volume status, including during recovery from a suspected lower respiratory tract infection/pneumonia and follow-up of fluid overload. Eight peak DOAC concentrations on the full dose ranged from 137 to 454 ng/mL and, after dose reduction, two peak DOAC concentrations were 152 and 103 ng/mL (Figure 1A). Measurements 1, 5 and 7 were above the expected on-therapy range, whereas the remaining measurements were within the expected on-therapy range. The intra-individual variability of peak DOAC concentrations was 47.1%, expressed as the CV. Across the sampling interval, eGFR ranged from 21 to 44 mL/min/1.73 m². The highest peak DOAC concentration occurred alongside the highest eGFR (measurement 1), while the lowest eGFR coincided with an in-range peak DOAC concentration (measurement 9).
A 96-year-old woman (54 kg) with AF received edoxaban 30 mg once daily. Seven peak DOAC concentrations were obtained, ranging from 98 to 226 ng/mL (Figure 1B). Routine blood draws were performed for periodic monitoring. Out-of-range values were observed at measurements 4, 5 and 7, whereas all other measurements were within the expected on-therapy range. Peak DOAC concentrations showed a CV of 33.6%, reflecting intra-individual variability across measurements. During the measurement period, eGFR ranged from 22.9 to 38 mL/min/1.73 m². The highest peak DOAC concentration was recorded at measurement 7, when eGFR was also highest. In contrast, the lowest eGFR (measurement 3) was accompanied by a peak DOAC concentration within the expected on-therapy range. Over time, peak DOAC concentrations increased as eGFR gradually declined. When eGFR improved, peak DOAC concentrations initially moved towards the expected on-therapy range before increasing again.
A 78-year-old man with AF received rivaroxaban 20 mg once daily. Routine blood draws were performed for periodic monitoring. Four peak DOAC concentrations were measured, ranging from 312 to 1011 ng/mL (Figure 1C). Measurement 1 was within the expected on-therapy range, whereas measurements 2, 3 and 4 were above the expected on-therapy range. Across the four measurements, the coefficient of variation (CV) for peak DOAC concentrations was 61.0%. During the measurement period, eGFR ranged from 71 to 82.6 mL/min/1.73 m². As shown in Figure 1C, measurement 1 had the highest eGFR and a peak DOAC concentration within the expected on-therapy range. Thereafter (measurements 2 – 4), peak DOAC concentrations increased while eGFR declined slightly and remained within a relatively narrow range.
An 85-year-old woman with AF received dabigatran 110 mg twice daily. Blood testing was requested for renal function and electrolyte monitoring, including follow-up after initiation of spironolactone. Two peak DOAC concentrations were measured (87 ng/mL and 70 ng/mL) (Figure 1D). Measurement 1 was within the expected on-therapy range, whereas measurement 2 was below the expected on-therapy range. For peak DOAC concentrations, intra-individual variability was quantified by a CV of 15.3%. During the measurement period, eGFR ranged from 46.7 to 60 mL/min/1.73 m².
Across cases, approximately 12-15 oral medicines were used; no systemic strong CYP3A4 or P-gp inhibitors or inducers were documented.
Serial peak DOAC levels in four frail nursing-home residents
Figure 1: Serial peak DOAC concentrations over time in four frail nursing-home residents treated with apixaban, edoxaban, rivaroxaban or dabigatran for AF.
Each panel represents one case. Horizontal reference lines or shaded areas indicate the expected on-therapy peak range for AF for the corresponding DOAC and dose. Points outside the expected range indicate out-of-range DOAC levels. Across 23 peak DOAC levels, 10 were outside the expected on-therapy range, including nine above and one below. CVs ranged from 15.3% to 61.0%, indicating variable degrees of intra-individual fluctuation between cases.
This case series provides a detailed characterisation of intra-individual variability in DOAC concentrations in a nursing-home population. Almost half (43%) of all DOAC concentrations measured were outside the expected on-therapy range. CVs ranged from 15.3% to 61.0%, with two cases above the upper end commonly reported in general outpatient cohorts (15%-35%) [13, 14, 16]. Together, these findings suggest that fixed DOAC dosing may not consistently result in expected on-therapy ranges in frail nursing-home residents. Longitudinal data on DOAC concentrations in nursing-home residents appear limited and available longitudinal studies in frail older adults have largely focused on hospitalised populations rather than long-term care [2, 14]. Even with standardised administration, peak DOAC concentrations shifted repeatedly between on-therapy and out-of-range values.
Renal function is a recognised determinant of DOAC exposure, as all DOACs undergo renal elimination to some extent, most prominently dabigatran and to a lesser extent factor Xa inhibitors [18, 19]. In older adults, renal function may fluctuate during intercurrent illness, dehydration or heart failure, potentially affecting DOAC concentrations [10, 18-20]. In the present case series, renal function was often reduced and varied within residents, but eGFR changes were not consistently paralleled by changes in peak DOAC concentrations. This suggests that renal function may have contributed to exposure, but was unlikely to be the sole factor associated with the observed intra-individual variability. Because samples were obtained during routine nursing-home blood testing, mainly for monitoring renal function, electrolytes or volume status, and occasionally during intercurrent illness, these data reflect real-world practice. However, the heterogeneous indications and opportunistic timing of sampling limit firm conclusions about the extent to which renal function explained out-of-range concentrations.
Polypharmacy is highly prevalent in nursing-home residents [21]. Concomitant medicines may influence DOAC pharmacokinetics through CYP3A4 enzymes and P-gp pathways [10]. Across the four cases, polypharmacy was substantial (approximately 12-15 oral medicines per case), yet no systemic strong CYP3A4 or P-gp inhibitors or inducers were documented. Variability in peak DOAC concentrations nevertheless persisted, suggesting that contributors beyond recognised strong drug-drug interactions may be important in this setting.
Besides renal function and drug-drug interactions, frailty and liver disease may also influence DOAC concentrations in older adults. Eidam et al. reported higher dose-normalised apixaban trough concentrations in older adults with performance-based frailty [22]. Furthermore, liver disease remains a clinically relevant context for DOAC use. Mostly, because hepatic clearance is important in drug metabolism. Nevertheless, evidence in moderate-to-severe liver disease is limited [23]. In the present case series, liver function was not systematically recorded. Therefore, hepatic dysfunction could not be assessed as a potential contributor to the observed variability.
Age-related physiological change may be one explanation for the variability observed in these cases. In older adults, reductions in lean mass and total body water, increases in fat mass and age-related changes in gastrointestinal function and hepatic clearance can alter DOAC distribution and handling [10, 20]. Across the four residents, peak DOAC concentrations at a fixed prescribed dose shifted over time between within expected on-therapy range and outside the expected on-therapy range measurements despite standardised administration. This intra-individual variation may reflect age associated and frailty associated changes in absorption, distribution and clearance that can vary over time in nursing-home residents. Episodes of acute illness may further contribute, as clinical instability can transiently alter pharmacokinetics and has previously coincided with unexpected DOAC concentration shifts in the DOAC-FRAIL pilot study [2].
Strengths of this case series are the availability of serial peak DOAC concentrations in nursing-home residents under standardised administration and measurement with validated drug-specific assays, a setting for which longitudinal data are scarce. Limitations are the small sample size and the use of peak-only measurements, which precludes assessment of trough exposure and overall exposure. Because samples were obtained as part of routine nursing-home monitoring and sometimes during intercurrent illness, the measurements reflect real-world practice. This context enhances clinical relevance but limits inference regarding prevalence of out-of-range concentrations and their direct association with bleeding or thrombotic events.
Recent evidence indicates that DOAC concentrations below and above the expected on-therapy range are associated with increased risks of thromboembolic events and bleeding, respectively [24]. In this context, intra-individual variability in frail nursing-home residents is clinically relevant because it may increase the likelihood of excursions into ranges associated with harm.
This case series suggests that peak DOAC concentrations may vary substantially over time in frail nursing-home residents, even under standardised medication administration. The observed variability was not consistently explained by renal function or documented systemic strong CYP3A4/P-gp inhibitors or inducers. Prospective studies in frail older adults, including nursing-home residents, are needed to determine whether selective concentration assessment and dose adjustment can improve the safety and precision of DOAC therapy in this population.
The authors thank the participating nursing-home residents and their legal representatives, as well as the nursing-home staff involved in routine care and blood sampling.
This work received no external funding.
Conflict of Interest Statement
Daan Teerds: No conflicts of interest to disclose.
Irme S. Franssen: No conflicts of interest to disclose.
Dionne C.W. Braeken: No conflicts of interest to disclose.
Dave Hellenbrand: No conflicts of interest to disclose.
Yvonne Henskens: No conflicts of interest to disclose.
Melanie J. de Jong: No conflicts of interest to disclose.
Fabienne J.H. Magdelijns: No conflicts of interest to disclose.
Author Contributions
Study concept and design: Daan Teerds, Irme S. Franssen, Fabienne J.H. Magdelijns.
Acquisition of data: Daan Teerds, Irme S. Franssen, Dionne C.W. Braeken, Melanie J. de Jong.
Laboratory analysis and data generation: Daan Teerds, Dave Hellenbrand, Yvonne Henskens.
Analysis and interpretation of data: Daan Teerds, Irme S. Franssen, Dave Hellenbrand, Yvonne Henskens, Fabienne J.H. Magdelijns.
Drafting of the manuscript: Daan Teerds.
Critical revision of the manuscript for important intellectual content: Irme S. Franssen, Dionne C.W. Braeken, Dave Hellenbrand, Yvonne Henskens, Melanie J. de Jong, Fabienne J.H. Magdelijns.
Supervision: Fabienne J.H. Magdelijns.
All authors approved the final version and agree to be accountable for all aspects of the work.
Data Availability Statement
The data underlying this article are not publicly available because they contain individual-level clinical information from frail nursing-home residents. De-identified data may be made available by the corresponding author upon reasonable request and subject to applicable privacy and ethical restrictions.
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Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
