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Direct Oral Anticoagulants (DOACs) in the Laboratory: 2015 Review

D M Adcock1, R Gosselin2

  • 1Colorado Coagulation, Laboratory Corporation of America® Holdings, Englewood, CO, United States.

Thrombosis Research
|May 19, 2015
PubMed

Insights

New direct oral anticoagulants (DOACs) offer potential benefits over warfarin. This review details their clinical use, mechanisms, and laboratory assay effects, including specialized testing for drug monitoring.

Area of Science:

  • Pharmacology
  • Clinical Chemistry
  • Hematology

Background:

  • Direct oral anticoagulants (DOACs) are emerging therapies for anticoagulation.
  • DOACs include direct anti-factor Xa and direct thrombin inhibitors.
  • These agents may offer advantages over traditional vitamin K antagonists like warfarin.

Purpose of the Study:

  • To review the clinical utility and mechanisms of action of DOACs.
  • To detail the impact of DOACs on routine and specialty laboratory coagulation assays.
  • To discuss methods for monitoring DOAC concentrations in laboratory settings.

Main Methods:

  • Literature review of clinical studies and laboratory investigations.
  • Analysis of the effects of DOACs on activated partial thromboplastin time (APTT) and prothrombin time (PT) assays.
  • Evaluation of drug-specific assays and alternative monitoring methods.

Main Results:

  • DOACs exhibit distinct effects on various coagulation assays.
  • Standard APTT and PT assays may not accurately reflect anticoagulation intensity with DOACs.
  • Drug-specific assays and calibrated anti-Xa assays are valuable for monitoring DOAC levels.

Conclusions:

  • Understanding DOAC effects on laboratory assays is crucial for accurate patient management.
  • Specialized testing and monitoring strategies are necessary for DOAC therapy.
  • DOACs represent a significant advancement in anticoagulant therapy requiring tailored laboratory support.
Keywords:
DOACDirect Xa inhibitorDirect thrombin inhibitorLaboratory assaysOral anticoagulant

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