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Assessing Direct Oral Anticoagulants in the Clinical Laboratory.

Robert C Gosselin1, Adam Cuker2

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Direct oral anticoagulants (DOACs) offer convenience but may require monitoring in emergencies. This study reviews tests for detecting DOACs and measuring their levels, aiding clinical decisions.

Keywords:
Anti-XaApixabanDabigatranDirect oral anticoagulants (DOACs)EdoxabanLaboratoryRivaroxaban

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Area of Science:

  • Pharmacology
  • Clinical Chemistry
  • Hematology

Background:

  • Direct oral anticoagulants (DOACs) offer advantages over vitamin K antagonists, including reduced need for routine laboratory monitoring.
  • However, assessing DOAC effect and concentration is crucial for managing clinical situations, especially emergencies and reversals.
  • Understanding DOACs' impact on other coagulation assays is also important.

Purpose of the Study:

  • To review available tests for screening DOAC presence.
  • To identify tests that accurately quantify DOAC exposure, comparable to gold standards.
  • To discuss the influence of DOACs on other coagulation tests and heparin monitoring strategies.

Main Methods:

  • Literature review of diagnostic tests for DOACs.
  • Analysis of studies validating DOAC quantification assays against established methods.
  • Examination of research on DOAC interference with coagulation assays.

Main Results:

  • Several tests can effectively screen for the presence of DOACs.
  • Specific assays demonstrate equivalence to gold standard methods for quantifying DOAC levels.
  • DOACs can affect results of other coagulation assays, necessitating specific monitoring strategies.

Conclusions:

  • Validated tests exist for both screening and quantifying DOACs, crucial for clinical decision-making.
  • Awareness of DOACs' effects on other coagulation tests is vital for accurate interpretation and management.
  • Effective strategies are available for monitoring unfractionated heparin in patients also taking DOACs.