Clinical pearls: Laboratory assessments of direct oral anticoagulants (DOACS)

Summary

Direct oral anticoagulants (DOACS) are used for stroke prevention in patients with atrial fibrillation as well as for prophylaxis and treatment of venous thromboembolism.

Clinicians who treat, or may encounter, patients with DOAC exposure, should be aware of the limitations of coagulation testing in this setting, and seek counsel from their laboratory to understand the effects of DOACS on coagulation results. Generally, assays that employ clot based principles, or methods that require thrombin or Factor Xa activation or substrates may be affected by the presence of DOACS. The clinical laboratory should have an algorithmic testing plan for adequately assessing the presence of all DOACS and readily provide this information to clinicians. We describe Clinical Pearls for DOAC assessment using common and esoteric coagulation testing.

Zusammenfassung

Direkte orale Antikoagulanzien (DOAK) werden zur Schlaganfallprophylaxe bei Patienten mit Vorhofflimmern und zur Prophylaxe sowie Behandlung von venösen Thrombembolien eingesetzt. Ärzte, die Patienten unter DOAK-Therapie behandeln oder mit diesen konfrontiert werden, sollten sich über die Grenzen der Bestimmung der Gerinnungswerte unter diesen Bedingungen im Klaren sein. Sie sollten den Rat ihres Labors einholen, um die Wirkungen der DOAK auf die Gerinnungswerte richtig einzuschätzen. Generell können Assays, die auf funktionellen Clotting-Tests basieren, oder Methoden, die Thrombin oder Faktor Xa als Substrat verwenden bzw. deren Aktivierung erfordern, von DOAK beeinflusst werden. Das klinische Labor sollte über einen algorithmischen Testplan verfügen, um die Präsenz aller DOAK in geeigneter Weise zu beurteilen und den Ärzten diese Informationen umgehend zur Verfügung stellen zu können. Wir beschreiben klinische Perlen für die DOAK-Untersuchung anhand der üblichen Gerinnungstests wie auch selteneren Verfahren.

Nachdruck aus und zu zitieren als: Hämostaseologie 2017; 37: 295–301

Keywords

Dabigatran - rivaroxaban - apixaban - edoxaban - direct oral anticoagulants

Schlüsselwörter

Dabigatran - Rivaroxaban - Apixaban - Edoxaban - direkte orale Antikoagulanzien

 

Conflict of interest

RCG provides expert testimony for laboratory monitoring or rivaroxaban and dabigatran, advisory board for NovoNordisk, Roche Diagnostics; JD is the founder of QUALIblood s.a., reports personal fees from Stago, Daiichi-Sankyo, Roche Diagnostics and Roche, outside the submitted work; DA reports personal fees from Stago and Roche outside the submitted work, clinical advisor to Instrumentation Laboratory.

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