Testing direct oral anticoagulants: embedding in structured long-term care

Abstract

Preview
Since the introduction of the new class of direct oral anticoagulants (DOAC) several years ago (initially referred to as new oral anticoagulants, currently also as non-vitamin K dependent oral anticoagulants, or NOAC) these agents are increasingly replacing vitamin K antagonists (VKA) for the major indications, prevention of embolic stroke in patients with atrial fibrillation1 and treatment and secondary prevention of venous thromboembolism2. The use of DOAC is also picking up in countries with a certain tradition in the structured management of VKA treatment, such as Italy3, which is in line with current international guidelines indicating preference for DOAC over VKA for several, but not all, indications. One of the key marketing issues for DOAC is the lack of need for laboratory testing, which deviates from the mandatory international normalised ratio testing in patients on VKA. Indeed, the lack of frequent blood draws (or capillary blood sampling) and the consequent repeated dose adjustments needed for VKA, are clear practical advantages of the use of DOAC. [...]