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Progress in the monitoring of direct oral anticoagulant therapy
Author(s) -
Patel Jignesh P.,
Byrne Rosalind A.,
Patel Raj K.,
Arya Roopen
Publication year - 2019
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15756
Subject(s) - medicine , oral anticoagulant , intensive care medicine , vitamin k , clinical practice , warfarin , low molecular weight heparin , heparin , atrial fibrillation , physical therapy
Summary The availability of direct oral anticoagulants ( DOAC s) has led to a paradigm shift in the field of anticoagulation, with DOAC s increasingly being prescribed for patients in preference to vitamin K antagonists and low molecular weight heparin. Despite good experience with the use of these agents at fixed doses, there are clinical scenarios where monitoring is recommended. Data from phase III studies of the DOAC s and small real‐world studies suggest a relationship between DOAC concentration and clinical events. The DOAC s have differing impacts on the common tests of haemostasis and it is important that clinicians are familiar with the sensitivity of the reagents used in their laboratory to individual DOAC s. The specific DOAC drug concentrations can be assayed in the laboratory, when required, to guide appropriate clinical decision‐making. Studies from the real world with sufficient numbers evaluating the association of DOAC concentrations with outcomes should be a research priority in order to understand if we could do better through dose individualisation.