The laboratory's 2015 perspective on direct oral anticoagulant testing

Journal of Thrombosis and Haemostasis : JTH
Robert Gosselin, Dorothy M Adcock

Abstract

The introduction of direct oral anticoagulant (DOAC) therapy into clinical use in the past 5 years has had significant impact on the clinical laboratory. Clinicians' desire to determine plasma drug presence or measure drug concentration, and more recent observations regarding the limitations and utility of coagulation testing in the setting of DOAC treatment, suggest that early published recommendations regarding laboratory testing should be reassessed. These initial recommendations, furthermore, were often based on drug-spiked plasma studies, rather than samples from patients receiving DOAC therapy. We have demonstrated that reagent sensitivity varies significantly whether drug-spiked samples or samples from DOAC-treated patients are tested. Data from drug-enriched samples must therefore be interpreted with caution or be used as a guide only. We present laboratory assays that can be used to determine drug presence and to measure drug concentration, and provide recommended testing algorithms. As DOAC therapy may significantly impact on specialty coagulation assays, we review those tests with the potential to give false-positive and false-negative results.

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Citations

Jul 6, 2017·Hämostaseologie·Robert C GosselinDorothy Adcock
Apr 7, 2018·Journal of Thrombosis and Haemostasis : JTH·H CohenD A Isenberg
Apr 4, 2019·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Tigran KhachatryanAnthony Hilliard
Oct 11, 2017·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Jolanta MalyszkoAnna Tomaszuk-Kazberuk
Oct 12, 2018·European Journal of Anaesthesiology·Claire PailleretCharles M Samama
Apr 16, 2020·Journal of Thrombosis and Haemostasis : JTH·Andreas HillarpTomas L Lindahl
Apr 2, 2019·Journal of Thrombosis and Haemostasis : JTH
Dec 2, 2017·Journal of Thrombosis and Haemostasis : JTH·J DouxfilsF Mullier
Jul 22, 2021·International Journal of Laboratory Hematology·Robert C Gosselin
Aug 3, 2021·Journal of Atherosclerosis and Thrombosis·Takako TerakamiEriko Morishita

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