Direct oral anticoagulants measurement: when is it necessary?

Abstract

Background. Direct oral anticoagulants (DOAC) are the mainstay for treatment/prevention of thrombosis in cardiovascular diseases. They are prescribed at fixed dosage based on patients’ characteristics. However, there are situations when laboratory assessment of DOAC plasma concentrations is crucial to help clinicians make decision.

Materials and Methods. This Commentary discusses the reasons for testing and the type of testing to be used.

Results. The occasions for testing include (i) adverse events; (i) before surgical or invasive procedures; (iii) before initiation of thrombolytic therapy; (iv) testing to look for interaction with additional drugs. The tests to be used are the dilute thrombin time for dabigatran and the anti-FXa assays for rivaroxaban, apixaban and edoxaban.

Discussion. Although DOACs are prescribed at fixed dosage without laboratory assistance for dose-adjustment, there are occasions when laboratory testing may be useful for patients’ management.