Laboratory testing in patients treated with direct oral anticoagulants: a practical guide for clinicians

@article{Douxfils2018LaboratoryTI,
  title={Laboratory testing in patients treated with direct oral anticoagulants: a practical guide for clinicians},
  author={Jonathan Douxfils and Walter Ageno and Charles Marc Samama and Sarah Lessire and Hugo ten Cate and Peter Verhamme and Jean Michel Dogn{\'e} and François Mullier},
  journal={Journal of Thrombosis and Haemostasis},
  year={2018},
  volume={16},
  pages={19 - 209}
}
Click to hear Dr Baglin's perspective on the role of the laboratory in treatment with new oral anticoagulants 
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References

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Poor comparability of coagulation screening test with specific measurement in patients receiving direct oral anticoagulants: results from a multicenter/multiplatform study
TLDR
PT, PTT and specific tests for DOACs were performed on patients treated for atrial fibrillation to measure direct oral anticoagulant action.
An optimised, rapid chromogenic assay, specific for measuring direct factor Xa inhibitors (rivaroxaban) in plasma.
An optimised, rapid chromogenic assay, specific for measuring direct factor Xa inhibitors (rivaroxaban) in plasma -
Clinical pearls: Laboratory assessments of direct oral anticoagulants (DOACS).
TLDR
Clinical Pearls for DOAC assessment using common and esoteric coagulation testing is described and it is suggested that the clinical laboratory should have an algorithmic testing plan for adequately assessing the presence of all DOACS.
The laboratory's 2015 perspective on direct oral anticoagulant testing
TLDR
It is demonstrated that reagent sensitivity varies significantly whether drug‐spiked samples or samples from DOAC‐treated patients are tested, and laboratory assays that can be used to determine drug presence and to measure drug concentration are presented, and recommended testing algorithms are provided.
Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
TLDR
There is a large amount of evidence on laboratory and clinical characteristics of vitamin K antagonists and a growing body of evidence is becoming available on the first new oral anticoagulant drugs available for clinical use, dabigatran and rivaroxaban.
Comparison of the effect of the anti‐Xa direct oral anticoagulants apixaban, edoxaban, and rivaroxaban on coagulation assays
The purpose of this study is to compare the effect of increasing concentrations of direct anti‐Xa oral anticoagulants (DOAC) apixaban‐, edoxaban‐, and rivaroxaban‐enriched plasma samples on various
To measure or not to measure direct oral anticoagulants before surgery or invasive procedures: comment
TLDR
The effect of different dabigatran concentrations on the APTT is studied, using six different APTT reagents and performed on three coagulation analyzer platforms.
Laboratory Monitoring of Non–Vitamin K Antagonist Oral Anticoagulant Use in Patients With Atrial Fibrillation: A Review
TLDR
Robust evidence from patients with atrial fibrillation randomized to NOACs or warfarin demonstrates that unmonitored NOAC therapy is at least as effective and safe as monitored warfarins, with lower rates of intracranial hemorrhage and reduced mortality.
Laboratory measurement of the direct oral anticoagulants: Indications and impact on management in clinical practice
TLDR
In conclusion, DOAC measurement was infrequently requested and differed between hospitalized patients and outpatients, and clinical response varied by drug level and indication.
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