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

  • Giuseppe Lippi ORCID logo EMAIL logo und Emmanuel J. Favaloro
Veröffentlicht/Copyright: 22. September 2014
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Clinical Chemistry and Laboratory Medicine (CCLM)
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine (CCLM) Band 53 Heft 2

Abstract

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

Keywords: apixaban; dabigatran; direct oral anticoagulants; edoxaban; measurement; rivaroxaban
Corresponding author: Prof. Giuseppe Lippi, Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy, Phone: +39-521-703050, Fax: +39-521-703791, E-mail:

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Received: 2014-7-25
Accepted: 2014-8-22
Published Online: 2014-9-22
Published in Print: 2015-2-1

©2015 by De Gruyter

Artikel in diesem Heft

  1. Frontmatter
  2. Editorials
  3. The new and the old of heparin-induced thrombocytopenia
  4. Biological variation – reliable data is essential
  5. Biological variation: back to basics
  6. Review
  7. Influence of educational, audit and feedback, system based, and incentive and penalty interventions to reduce laboratory test utilization: a systematic review
  8. Opinion Papers
  9. Recent guidelines and recommendations for laboratory assessment of the direct oral anticoagulants (DOACs): is there consensus?
  10. Meeting report: present state of molecular genetics in clinical laboratories. Report on the VII European Symposium on Clinical Laboratory and In Vitro Diagnostic Industry in Barcelona
  11. Genetics and Molecular Diagnostics
  12. Non-invasive prenatal diagnosis of monogenic disorders: an optimized protocol using MEMO qPCR with miniSTR as internal control
  13. A novel biosensor-based microarray assay for the visualized detection of CYP2C19 ∗2, ∗3, ∗4 and ∗5 polymorphisms
  14. General Clinical Chemistry and Laboratory Medicine
  15. Preanalytical errors: a preliminary approach to the point of view of primary health care givers
  16. Comparison of Improvacuter™ tubes with BD Vacutainer™ tubes for various hormones in the aspects of stability and influence of gel separators
  17. Use of quality indicators to compare point-of-care testing errors in a neonatal unit and errors in a STAT central laboratory
  18. Serological features of antibodies to protamine inducing thrombocytopenia and thrombosis
  19. Comparison of three different immunoassays in the diagnosis of heparin-induced thrombocytopenia
  20. How the direct oral anticoagulant apixaban affects hemostatic parameters. Results of a multicenter multiplatform study
  21. Auto-validation of complete blood counts in an outpatient’s regional laboratory
  22. Performance evaluation of the digital cell imaging analyzer DI-60 integrated into the fully automated Sysmex XN hematology analyzer system
  23. Circulating keratan sulfate as a marker of metabolic changes of cartilage proteoglycan in juvenile idiopathic arthritis; influence of growth factors as well as proteolytic and prooxidative agents on aggrecan alterations
  24. Reference Values and Biological Variations
  25. Biological variation database: structure and criteria used for generation and update
  26. Cardiovascular Diseases
  27. The tumor necrosis factor-α –238G/A and IL-6 –572G/C gene polymorphisms and the risk of idiopathic dilated cardiomyopathy: a meta-analysis of 25 studies including 9493 cases and 13,971 controls
  28. Diabetes
  29. Multicentre evaluation of the Premier Hb9210 HbA1c analyser
  30. Infectious Diseases
  31. Determination of quality control limits for serological infectious disease testing using historical data
  32. Corrigendum
  33. Enrichment and enumeration of circulating tumor cells by efficient depletion of leukocyte fractions
  34. Letters to the Editors
  35. Influence of age and gender on red blood cell distribution width
  36. Effect of exhaustive running exercise on red blood cell distribution width
  37. Clinically useful samples and reference change value
  38. Loss of retinol stability in patient samples
  39. Evaluation of a new thyroglobulin sensitive assay in patients with differentiated thyroid cancer
  40. Caution in a case of highly discrepant carbohydrate antigen 19-9 values in an apparently healthy patient taking spirulina: a case report
  41. Influence of vitamin K antagonist treatment on activated partial thromboplastin time
  42. Evaluation of the diagnostic characteristics of urinary kidney injury molecule 1 (uKIM-1) and uKIM-1/creatinine ratio in the assessment of incipient diabetic kidney disease
https://doi.org/10.1515/cclm-2014-0767
Schlagwörter für diesen Artikel
apixaban; dabigatran; direct oral anticoagulants; edoxaban; measurement; rivaroxaban

Artikel in diesem Heft

  1. Frontmatter
  2. Editorials
  3. The new and the old of heparin-induced thrombocytopenia
  4. Biological variation – reliable data is essential
  5. Biological variation: back to basics
  6. Review
  7. Influence of educational, audit and feedback, system based, and incentive and penalty interventions to reduce laboratory test utilization: a systematic review
  8. Opinion Papers
  9. Recent guidelines and recommendations for laboratory assessment of the direct oral anticoagulants (DOACs): is there consensus?
  10. Meeting report: present state of molecular genetics in clinical laboratories. Report on the VII European Symposium on Clinical Laboratory and In Vitro Diagnostic Industry in Barcelona
  11. Genetics and Molecular Diagnostics
  12. Non-invasive prenatal diagnosis of monogenic disorders: an optimized protocol using MEMO qPCR with miniSTR as internal control
  13. A novel biosensor-based microarray assay for the visualized detection of CYP2C19 ∗2, ∗3, ∗4 and ∗5 polymorphisms
  14. General Clinical Chemistry and Laboratory Medicine
  15. Preanalytical errors: a preliminary approach to the point of view of primary health care givers
  16. Comparison of Improvacuter™ tubes with BD Vacutainer™ tubes for various hormones in the aspects of stability and influence of gel separators
  17. Use of quality indicators to compare point-of-care testing errors in a neonatal unit and errors in a STAT central laboratory
  18. Serological features of antibodies to protamine inducing thrombocytopenia and thrombosis
  19. Comparison of three different immunoassays in the diagnosis of heparin-induced thrombocytopenia
  20. How the direct oral anticoagulant apixaban affects hemostatic parameters. Results of a multicenter multiplatform study
  21. Auto-validation of complete blood counts in an outpatient’s regional laboratory
  22. Performance evaluation of the digital cell imaging analyzer DI-60 integrated into the fully automated Sysmex XN hematology analyzer system
  23. Circulating keratan sulfate as a marker of metabolic changes of cartilage proteoglycan in juvenile idiopathic arthritis; influence of growth factors as well as proteolytic and prooxidative agents on aggrecan alterations
  24. Reference Values and Biological Variations
  25. Biological variation database: structure and criteria used for generation and update
  26. Cardiovascular Diseases
  27. The tumor necrosis factor-α –238G/A and IL-6 –572G/C gene polymorphisms and the risk of idiopathic dilated cardiomyopathy: a meta-analysis of 25 studies including 9493 cases and 13,971 controls
  28. Diabetes
  29. Multicentre evaluation of the Premier Hb9210 HbA1c analyser
  30. Infectious Diseases
  31. Determination of quality control limits for serological infectious disease testing using historical data
  32. Corrigendum
  33. Enrichment and enumeration of circulating tumor cells by efficient depletion of leukocyte fractions
  34. Letters to the Editors
  35. Influence of age and gender on red blood cell distribution width
  36. Effect of exhaustive running exercise on red blood cell distribution width
  37. Clinically useful samples and reference change value
  38. Loss of retinol stability in patient samples
  39. Evaluation of a new thyroglobulin sensitive assay in patients with differentiated thyroid cancer
  40. Caution in a case of highly discrepant carbohydrate antigen 19-9 values in an apparently healthy patient taking spirulina: a case report
  41. Influence of vitamin K antagonist treatment on activated partial thromboplastin time
  42. Evaluation of the diagnostic characteristics of urinary kidney injury molecule 1 (uKIM-1) and uKIM-1/creatinine ratio in the assessment of incipient diabetic kidney disease
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