Measurement of heparin, direct oral anti‐coagulants and other non‐coumarin anti‐coagulants and their effects on haemostasis assays: A British Society for Haematology Guideline

Peter Baker; Sean Platton; Deepa J. Arachchillage; Steve Kitchen; Jignesh P. Patel; Renu Riat; Keith Gomez

doi:10.1111/bjh.19729

September 2, 2024British Journal of HaematologyOpen Access

Measurement of heparin, direct oral anti‐coagulants and other non‐coumarin anti‐coagulants and their effects on haemostasis assays: A British Society for Haematology Guideline

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Why the study?

To update healthcare professionals in the UK on the measurement of licensed non-coumarin anti-coagulants and their effects on laboratory assays based on literature since 2014.

Key Points

To provide updated evidence-based recommendations on laboratory measurement of non-coumarin anticoagulants and their interference with diagnostic haemostasis assays.
The British Society for Haematology Haemostasis and Thrombosis Task Force reviewed literature published since 2014 using systematic search criteria.
Evidence quality and recommendation strength were graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
The guideline evaluated monitoring strategies for unfractionated heparin, low-molecular-weight heparins, direct factor Xa inhibitors, dabigatran, and argatroban across diverse clinical settings.
Activated partial thromboplastin time (APTT) exhibits significant inter-reagent variability and poor specificity for unfractionated heparin, making chromogenic anti-FXa assays the preferred monitoring method when testing is required.
Routine concentration monitoring is not recommended for fixed-dose direct oral anticoagulants or low-molecular-weight heparins, but calibrated anti-FXa or diluted thrombin time assays define expected drug levels during acute bleeding or emergency surgery.
Direct oral anticoagulants and heparins cause widespread, variable interference in clotting assays, specialized factor assays, and lupus anticoagulant testing, which can be partially mitigated by timed sampling or activated charcoal adsorption.

Structured PICO

P

Population

Patients receiving non-coumarin anti-coagulants (including unfractionated heparin, low-molecular-weight heparin, direct oral anti-coagulants, and argatroban) in the UK

I

Intervention

Laboratory measurement and monitoring of anti-coagulants (e.g., anti-FXa, anti-FIIa, APTT)

This British Society for Haematology guideline updates recommendations on the laboratory measurement of non-coumarin anticoagulants, emphasizing the utility of anti-FXa and anti-FIIa assays over traditional APTT in certain clinical scenarios.

Implication

Clinicians should prioritize anti-FXa and anti-FIIa assays for accurate monitoring; extends prior guidance by clarifying APTT limitations in non-coumarin use.

Abstract

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Discussion

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Cite This Study

Baker et al. (2024) studied this question.

synapsesocial.com/papers/6a0fa6dc5725bbd5cc5ff408 https://doi.org/10.1111/bjh.19729

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Measurement of heparin, direct oral anti‐coagulants and other non‐coumarin anti‐coagulants and their effects on haemostasis assays: A British Society for Haematology Guideline

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Measurement of heparin, direct oral anti‐coagulants and other non‐coumarin anti‐coagulants and their effects on haemostasis assays: A British Society for Haematology Guideline

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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