Recent guidelines and recommendations for laboratory assessment of the direct oral anticoagulants (DOACs): is there consensus?

摘要: A new generation of antithrombotic agents, which are conventionally known as direct oral anticoagulants (DOACs), have recently emerged and continuing to be developed. These provide inhibition either thrombin (factor IIa; FIIa) or activated factor X (FXa) currently include dabigatran (FIIa inhibitor) rivaroxaban, apixaban, edoxaban (FXa inhibitors). The dogma that DOACs do not require laboratory monitoring is countered by ongoing recognition testing for drug effects needed in many situations. In this review, we summarize the background establishment DOACs, assess tests were found useful screen quantitate effects/levels, then review published guidelines/recommendations concordance. brief, (a) anti-FIIa agent dabigatran, recommended screening assays partial thromboplastin time (APTT) and/or (TT), quantitative (using a standard) dilute TT/direct inhibitor assay (Hemoclot an ecarin-based such ecarin clot (ECT); (b) anti-FXa prothrombin (PT), but was endorsed all guidelines, specific rivaroxaban assay; (c) general insensitivity PT APTT prevented most groups from providing recommendation, instead there generalized support assessment using apixaban standard; (d) insufficient data other agents limited guidance literature.