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Direct oral anticoagulants: When to consider laboratory testing?
Author(s) -
ten Cate H.,
Olie R. H.,
ten CateHoek A. J.,
Henskens Y. M. C.
Publication year - 2018
Publication title -
international journal of laboratory hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.705
H-Index - 55
eISSN - 1751-553X
pISSN - 1751-5521
DOI - 10.1111/ijlh.12816
Subject(s) - medicine , intensive care medicine , rivaroxaban , apixaban , venous thromboembolism , thrombosis , warfarin , surgery , atrial fibrillation
Direct oral anticoagulants ( DOAC s) are increasingly prescribed for prevention of thromboembolic stroke, as well as for prevention and treatment of venous thromboembolism. Dose adjustment based on laboratory testing is not required; however, there are several potential situations that deserve insight into a DOAC plasma activity level. Methods Based on a series of real‐life case descriptions, we discuss indications for dedicated DOAC testing, as well as the interpretation and consequences. Results Testing of DOAC s in selected patients may help to better interpret acute situations such as bleeding or thrombosis while on anticoagulation, but also suspected drug failure, drug accumulation, or lack of adherence. Conclusion The 24/7 availability of target‐specific tests with adequate calibration is recommended to support the clinician in the interpretation and where needed adjustment of the management of patients on DOAC s. The relevance of laboratory‐guided DOAC management, particularly in the elderly, merits further study.