Laboratory drug-level monitoring of direct oral anticoagulants may aid clinical decision-making in high-risk patients, despite technical and regulatory barriers limiting widespread implementation.
Does laboratory drug-level monitoring of DOACs improve anticoagulation management in high-risk patient groups?
This review highlights the potential clinical utility of DOAC drug-level monitoring in specific high-risk scenarios and the need to overcome technical and regulatory barriers for its widespread implementation.
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.
Qiao et al. (Mon,) conducted a review in Anticoagulation therapy. Laboratory drug-level monitoring was evaluated. Laboratory drug-level monitoring of direct oral anticoagulants may aid clinical decision-making in high-risk patients, despite technical and regulatory barriers limiting widespread implementation.