Key result
New anticoagulants may reduce the need for strict laboratory monitoring compared to traditional therapies, though some monitoring will likely still be required for selected patient categories.
Despite the development of new anticoagulants designed to avoid laboratory monitoring, clinical laboratories should remain prepared to monitor selected patient categories.
Clinical labs should retain selective monitoring capacity with new anticoagulants; leaves open optimal protocols for specific populations.
The treatment of choice for acute venous thromboembolism is anticoagulant therapy with fast-acting drugs (unfractionated or low-molecular-weight heparin or fondaparinux) aimed at preventing thrombus extension, followed by extended prophylaxis with vitamin K antagonists aimed at preventing recurrence. Experience accumulated over the years has demonstrated that strict laboratory monitoring is required for unfractionated heparin and vitamin K antagonists, making use of these drugs problematic for patients and physicians and prompting researchers to develop new anticoagulants equally effective but without the requirement for laboratory monitoring. The results of clinical trials to date, albeit limited, suggest that these new drugs will probably keep their promise. However, the definitive answer will come subsequent to these clinical trials, when clinicians will start to use these drugs to treat patients in the real world. It is likely that some sort of laboratory monitoring will be required at least for selected categories of patients. Accordingly, clinical laboratories should still be prepared to monitor patients, although the numbers may hopefully decrease sharply in the next decade or so.
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Tripodi et al. (2009) conducted a review in Acute venous thromboembolism. New anticoagulants vs. Unfractionated heparin and vitamin K antagonists was evaluated. New anticoagulants may reduce the need for strict laboratory monitoring compared to traditional therapies, though some monitoring will likely still be required for selected patient categories.
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