Availability of direct oral anticoagulants testing among Italian anticoagulation clinics: a rapid evolution of clinical practice

Background: Direct oral anticoagulants (DOACs) are largely prescribed, and the lack of need for a laboratory monitoring was the main reason for their large diffusion. However, a wide inter-individual variability has been described, and the need for blood levels measurement when a thrombotic or hemorrhagic event occurred has been suggested. Materials and methods: In 2022, a survey was conducted among the Italian centers affiliated with the Italian Federation of Centers for the Diagnosis of Thrombotic Disorders and the Surveillance of the Antithrombotic Therapies - FCSA, recording that only few centers provided DOACs testing. In 2025, a second survey was performed to evaluate if a change in that area have occurred. Results: We observed a rapid increase in the number of centers providing DOAC testing, from 39/124 (31.0%) in 2022 to 72/122 (59.0%) in 2025; 26% of centers not providing DOAC testing, claimed no funding for testing. In 70/72 (97.2%) of centers, DOAC testing was limited to selected conditions, such as thrombotic or hemorrhagic complications. Conclusions: Data derived from our survey are relevant in developing adequate anticoagulation stewardship programs, that are increasingly required.