Challenges to Laboratory Monitoring of Direct Oral Anticoagulants
Direct oral anticoagulants (DOACs) exert anticoagulation effect by directly inhibiting Factor Xa (rivaroxaban, apixaban, and edoxaban) or thrombin (dabigatran). Though DOACs are characterized by fixed-dose prescribing and generally do not require routine laboratory drug-level monitoring (DLM), circu...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2024-03-01
|
| Series: | Clinical and Applied Thrombosis/Hemostasis |
| Online Access: | https://doi.org/10.1177/10760296241241524 |
| _version_ | 1797194196057063424 |
|---|---|
| author | Jesse Qiao MD Minh-Ha Tran DO |
| author_facet | Jesse Qiao MD Minh-Ha Tran DO |
| author_sort | Jesse Qiao MD |
| collection | DOAJ |
| description | Direct oral anticoagulants (DOACs) exert anticoagulation effect by directly inhibiting Factor Xa (rivaroxaban, apixaban, and edoxaban) or thrombin (dabigatran). Though DOACs are characterized by fixed-dose prescribing and generally do not require routine laboratory drug-level monitoring (DLM), circumstances may arise where the DLM may aid in clinical decision-making, including DOAC dose adjustment, anticoagulant class change, or decisions to withhold or administer reversal agents. We review the current literature that describes high-risk patient groups in which DLM may be beneficial for improved patient anticoagulation management and stewardship. The review also summarizes the limitations of conventional coagulation testing and discuss the emerging utility of quantitative methods for routine and rapid emergent evaluation of DOAC drug levels—in particular, the Anti-Xa activity to detect Factor Xa Inhibitors (rivaroxaban, apixaban, and edoxaban). Both technical and regulatory barriers to widespread DLM implementation are limiting factors to further clinical research that must be overcome, in order to propose universal DOAC DLM strategies and provide clinical-laboratory correlation to formally classify high-risk patient groups. |
| first_indexed | 2024-04-24T05:52:26Z |
| format | Article |
| id | doaj.art-847e2d2ea399434ebadea7950b6cc880 |
| institution | Directory Open Access Journal |
| issn | 1938-2723 |
| language | English |
| last_indexed | 2024-04-24T05:52:26Z |
| publishDate | 2024-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical and Applied Thrombosis/Hemostasis |
| spelling | doaj.art-847e2d2ea399434ebadea7950b6cc8802024-04-23T10:03:40ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232024-03-013010.1177/10760296241241524Challenges to Laboratory Monitoring of Direct Oral AnticoagulantsJesse Qiao MDMinh-Ha Tran DODirect oral anticoagulants (DOACs) exert anticoagulation effect by directly inhibiting Factor Xa (rivaroxaban, apixaban, and edoxaban) or thrombin (dabigatran). Though DOACs are characterized by fixed-dose prescribing and generally do not require routine laboratory drug-level monitoring (DLM), circumstances may arise where the DLM may aid in clinical decision-making, including DOAC dose adjustment, anticoagulant class change, or decisions to withhold or administer reversal agents. We review the current literature that describes high-risk patient groups in which DLM may be beneficial for improved patient anticoagulation management and stewardship. The review also summarizes the limitations of conventional coagulation testing and discuss the emerging utility of quantitative methods for routine and rapid emergent evaluation of DOAC drug levels—in particular, the Anti-Xa activity to detect Factor Xa Inhibitors (rivaroxaban, apixaban, and edoxaban). Both technical and regulatory barriers to widespread DLM implementation are limiting factors to further clinical research that must be overcome, in order to propose universal DOAC DLM strategies and provide clinical-laboratory correlation to formally classify high-risk patient groups.https://doi.org/10.1177/10760296241241524 |
| spellingShingle | Jesse Qiao MD Minh-Ha Tran DO Challenges to Laboratory Monitoring of Direct Oral Anticoagulants Clinical and Applied Thrombosis/Hemostasis |
| title | Challenges to Laboratory Monitoring of Direct Oral Anticoagulants |
| title_full | Challenges to Laboratory Monitoring of Direct Oral Anticoagulants |
| title_fullStr | Challenges to Laboratory Monitoring of Direct Oral Anticoagulants |
| title_full_unstemmed | Challenges to Laboratory Monitoring of Direct Oral Anticoagulants |
| title_short | Challenges to Laboratory Monitoring of Direct Oral Anticoagulants |
| title_sort | challenges to laboratory monitoring of direct oral anticoagulants |
| url | https://doi.org/10.1177/10760296241241524 |
| work_keys_str_mv | AT jesseqiaomd challengestolaboratorymonitoringofdirectoralanticoagulants AT minhhatrando challengestolaboratorymonitoringofdirectoralanticoagulants |