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ADLM Guidance Document on Coagulation Testing in Patients Using Direct Oral Anticoagulants

Lindsay A L Bazydlo1, Maximo J Marin2, Anna E Merrill3

  • 1Department of Pathology, University of Virginia, Charlottesville, VA, United States.

The Journal of Applied Laboratory Medicine
|November 5, 2025
PubMed

Insights

Direct oral anticoagulants (DOACs) simplify treatment but impact coagulation tests. This guide helps interpret results and manage testing for patients on DOACs, ensuring accurate hemostasis assessment.

Area of Science:

  • Clinical Chemistry
  • Hematology
  • Pharmacology

Background:

  • Coagulation testing is vital for diagnosing and managing hemostasis disorders.
  • Direct oral anticoagulants (DOACs) offer convenient anticoagulation but present challenges for standard laboratory testing.
  • Understanding DOAC interference is crucial for accurate patient assessment.

Purpose of the Study:

  • To provide guidance on coagulation tests affected by DOACs.
  • To discuss methods for mitigating DOAC interference in testing.
  • To outline strategies for testing and interpreting DOAC concentrations.

Main Methods:

  • Literature review of DOAC impact on coagulation assays.
  • Analysis of specific coagulation tests and their susceptibility to DOACs.
  • Evaluation of mitigation strategies and concentration testing.

Main Results:

  • Certain coagulation tests are significantly impacted by DOACs, potentially leading to inaccurate results.
  • Specific protocols can mitigate DOAC interference, allowing for reliable testing.
  • Methods exist to quantify DOAC concentrations for clinical interpretation.

Conclusions:

  • Coagulation testing in patients on DOACs requires careful consideration of drug interference.
  • Appropriate testing strategies and interpretation are essential for patient care.
  • This guidance aids clinicians in navigating coagulation testing complexities with DOAC therapy.
Abstract

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