Laboratory Monitoring and Measuring of Clinical Anticoagulants

Haemostasis reflects a balance between procoagulant and anticoagulant forces. A relative excess of procoagulant forces and/or a relative lack of anticoagulant forces can predispose individuals to an increased risk of thrombosis. Conversely, a relative lack of procoagulant forces and/or a relative excess of anticoagulant forces can predispose individuals to an increased risk of bleeding. It is possible in several clinical situations to mitigate bleeding risk using various approaches, including provision of procoagulant material; conversely, thrombosis risk can be mitigated by using various clinical anticoagulants. In some cases, such therapies require laboratory monitoring or measurements; in particular, therapy using anticoagulants may require laboratory measuring or monitoring to ensure adequate anticoagulation without over- or under-coagulating patients, and thereby reducing any treatment associated risk of bleeding or thrombosis. In this narrative review, we detail the various anticoagulants under current clinical use, as well as the tests or assays used to measure anticoagulant levels, or to monitor anticoagulant therapy.