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Related Concept Videos

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

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Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
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Drug concentration is the quantity of a drug present in a biological sample. Measuring drug amounts in biological samples allows the clinician to understand how a drug is absorbed, distributed, metabolized, and excreted. Samples can be obtained through invasive or non-invasive methods. Invasive techniques involve surgical or parenteral interventions to gather blood, cerebrospinal fluid, or tissue biopsy. Conversely, non-invasive approaches provide samples like urine, feces, and saliva.
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Measurement of Bioavailability: Pharmacodynamic Methods01:20

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Pharmacodynamic methods provide insights into a drug's effects on physiological processes over time and play a crucial role in understanding bioavailability and therapeutic efficacy. These methods can be broadly classified into acute pharmacological and therapeutic response approaches, each with distinct mechanisms and applications.The acute pharmacological response method directly correlates a drug's physiological effects, such as ECG or pupil diameter changes, to its time course in the body.
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Unlike direct titration, back-titration, and displacement titration, indirect titration is an EDTA titration method for quantifying anions. In the indirect titration method, anions are precipitated as their insoluble salts with excess metal ions. The filtrate containing the excess metal ions is directly titrated with standard EDTA until the endpoint is achieved. Another approach involves extracting the metal ion and back-titrating with standard EDTA to obtain the endpoint. In this way, the...
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IV Infusion to Oral Dosing: Conversion Methods01:28

IV Infusion to Oral Dosing: Conversion Methods

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The development of extended-release formulations has facilitated the transition from intravenous to oral medication, offering a more convenient and patient-friendly approach to drug administration. This transition, however, requires careful management to ensure that therapeutic drug levels are maintained, preserving efficacy and avoiding adverse effects. Understanding pharmacokinetic principles and dosage calculations is critical during this process.Pharmacokinetics of the...
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Measuring Direct Oral Anticoagulants.

Robert C Gosselin1, Jonathan Douxfils2

  • 1Department of Pathology and Laboratory Medicine, Davis Health System, University of California, 4400 V Street, Sacramento, CA, 95817, USA. rcgosselin@outlook.com.

Methods in Molecular Biology (Clifton, N.J.)
|August 15, 2017
PubMed
Summary

Direct oral anticoagulants (DOACs) can be measured in labs using standard equipment. Assays for direct thrombin inhibitors like dabigatran and direct anti-Xa inhibitors are available for clinical use.

Keywords:
Anti-XaApixabanDabigatranDilute thrombin timeDirect oral anticoagulantsEcarinEdoxabanRivaroxaban

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Area of Science:

  • Clinical Chemistry
  • Pharmacology
  • Hematology

Background:

  • Direct oral anticoagulants (DOACs) are increasingly prescribed for thrombotic conditions.
  • Accurate quantification of DOACs is essential for therapeutic drug monitoring and clinical research.
  • Standardized laboratory methods are needed for reliable DOAC measurement.

Purpose of the Study:

  • To describe available laboratory methods for quantifying direct oral anticoagulants.
  • To outline quantification strategies for direct thrombin inhibitors and direct Factor Xa inhibitors.

Main Methods:

  • DOACs can be quantified using manual or automated platforms in clinical and research laboratories.
  • Dabigatran etexilate (direct thrombin inhibitor) assays utilize drug-calibrated clot or chromogenic methods with thrombin or ecarin substrates.
  • Direct anti-Xa inhibitors (rivaroxaban, apixaban, edoxaban) are quantified using drug-calibrated anti-Xa kits, similar to heparin assays.

Main Results:

  • Established laboratory methods exist for the quantification of major DOACs.
  • Specific assay methodologies are detailed for different DOAC classes.
  • These methods are adaptable to various laboratory settings.

Conclusions:

  • DOAC quantification is feasible using existing laboratory infrastructure.
  • Drug-calibrated assays provide reliable measurement of dabigatran, rivaroxaban, apixaban, and edoxaban.
  • These methods support clinical management and research involving DOACs.