Direct oral anticoagulants (DOACs) do not require dose adjustment based on laboratory testing. How- ever, it might be necessary to measure their plasma concentrations in the following specific situations: 1) before thrombolytic therapy in patients with stroke; 2) before surgery or invasive procedure; 3) in case of adverse events (thrombosis or hemorrhage); 4) when immediate reversal of anticoagulation is needed; 5) in patients with extreme body weight; 6) when administering additional drugs potentially interfering with DOACs; and 7) when overdosage is suspected regardless of concomitant bleeding. Basic coagulation tests, such as prothrombin and activated partial thromboplastin time, should not be used as standalone tests to assess the levels of anticoagulation as they are not specific for DOACs and their results are dependent on the type of reagent used for testing. Plasma DOAC concentrations should be assessed by dedicated tests: dilute thrombin time or ecarin tests (for dabigatran) or anti–factor Xa as- says (for anti–factor Xa inhibitors). Dedicated tests should be calibrated against their respective plasma calibrators at certified DOAC concentrations and results should be expressed as ng/ml. Caution should be exerted when interpreting the results of the most common hemostatic parameters such as antithrombin, proteins C and S, lupus anticoagulant, or individual coagulation factors, as they may be strongly affected by the presence of a DOAC. Whenever possible, these parameters should be measured 4 to 5 days after discontinuation of DOAC anticoagulation.

How and when to measure anticoagulant effects of direct oral anticoagulants? Practical issues / A. Tripodi, S. Braham, B. Scimeca, M. Moia, F. Peyvandi. - In: POLSKIE ARCHIWUM MEDYCYNY WEWNETRZNEJ. - ISSN 0032-3772. - 128:6(2018 Jun), pp. 379-385. [10.20452/pamw.4287]

How and when to measure anticoagulant effects of direct oral anticoagulants? Practical issues

A. Tripodi
Primo
;
S. Braham
Secondo
;
B. Scimeca;F. Peyvandi
Ultimo
2018-06

Abstract

Direct oral anticoagulants (DOACs) do not require dose adjustment based on laboratory testing. How- ever, it might be necessary to measure their plasma concentrations in the following specific situations: 1) before thrombolytic therapy in patients with stroke; 2) before surgery or invasive procedure; 3) in case of adverse events (thrombosis or hemorrhage); 4) when immediate reversal of anticoagulation is needed; 5) in patients with extreme body weight; 6) when administering additional drugs potentially interfering with DOACs; and 7) when overdosage is suspected regardless of concomitant bleeding. Basic coagulation tests, such as prothrombin and activated partial thromboplastin time, should not be used as standalone tests to assess the levels of anticoagulation as they are not specific for DOACs and their results are dependent on the type of reagent used for testing. Plasma DOAC concentrations should be assessed by dedicated tests: dilute thrombin time or ecarin tests (for dabigatran) or anti–factor Xa as- says (for anti–factor Xa inhibitors). Dedicated tests should be calibrated against their respective plasma calibrators at certified DOAC concentrations and results should be expressed as ng/ml. Caution should be exerted when interpreting the results of the most common hemostatic parameters such as antithrombin, proteins C and S, lupus anticoagulant, or individual coagulation factors, as they may be strongly affected by the presence of a DOAC. Whenever possible, these parameters should be measured 4 to 5 days after discontinuation of DOAC anticoagulation.
Activated partial thromboplastin time; Anti–factor Xa assay; Dilute thrombin time; Prothrombin time; Internal Medicine
Settore MED/09 - Medicina Interna
Article (author)
File in questo prodotto:
File Dimensione Formato  
inv_rev_Prof.Tripodi.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 246.19 kB
Formato Adobe PDF
246.19 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/622101
Citazioni
  • ???jsp.display-item.citation.pmc??? 3
  • Scopus 24
  • ???jsp.display-item.citation.isi??? 24
social impact