ROTEM Testing for Direct Oral Anticoagulants

Area of Science:

• Hematology
• Clinical Pharmacology
• Medical Devices

Background:

• Direct oral anticoagulants (DOACs) are widely prescribed for stroke prevention in atrial fibrillation and venous thromboembolism.
• Monitoring DOACs activity is crucial in specific clinical scenarios like major bleeding or urgent procedures.
• Rotational thromboelastometry (ROTEM), a viscoelastic hemostatic assay (VHA), has established roles in emergency and surgical settings.

Purpose of the Study:

• To review the current applications of ROTEM in patients treated with DOACs.
• To explore the utility of ROTEM in managing DOACs-associated bleeding.
• To assess ROTEM's role in guiding reversal strategies for DOACs-induced anticoagulation.

Main Methods:

• Literature review of studies investigating ROTEM in DOAC-treated patients.
• Analysis of ROTEM's performance in assessing hemostasis in the presence of DOACs.
• Evaluation of ROTEM's potential for guiding hemostatic management and reversal therapies.

Main Results:

• Experience with ROTEM in DOAC-treated patients is still limited but growing.
• ROTEM may provide valuable information on the viscoelastic properties of blood affected by DOACs.
• The assay shows potential for guiding interventions in DOACs-related bleeding and reversal.

Conclusions:

• ROTEM is a promising tool for assessing hemostasis in patients on DOACs therapy.
• Further research is needed to fully establish ROTEM's role in managing DOACs-associated bleeding and guiding reversal.
• ROTEM may enhance clinical decision-making in critical care settings involving DOACs.