[Monitoring of NOAC]

Area of Science:

• Pharmacology
• Clinical Chemistry
• Internal Medicine

Background:

• Non-vitamin K antagonist oral anticoagulants (NOACs) are widely used anticoagulants.
• Routine monitoring of NOACs is generally not required.
• However, monitoring may be beneficial in select patient populations.

Purpose of the Study:

• To identify patient subgroups who could benefit from NOAC monitoring.
• To describe available methods for monitoring NOACs.
• To outline which coagulation parameters are affected by NOACs.

Main Methods:

• A systematic literature search was conducted using PubMed.
• Search terms included NOAC, DOAC, rivaroxaban, dabigatran, apixaban, and monitoring-related terms.
• Results were compiled and reviewed to synthesize findings.

Main Results:

• Monitoring is most advantageous in emergency bleeding cases to assess drug activity.
• It aids decisions regarding thrombolysis after stroke in NOAC patients.
• Monitoring can identify compliance issues and inform periprocedural management.
• Quantitative methods (diluted thrombin time for dabigatran, anti-factor Xa for rivaroxaban/apixaban) are recommended over qualitative ones.

Conclusions:

• Specific patient subgroups can benefit from monitoring NOAC plasma concentrations.
• Considerations before measurement include the objective, potential consequences (e.g., dose adjustment), and appropriate method selection.