Rapid Measurement of Direct Oral Anticoagulants for Clinical Decision-Making

Background Direct oral anticoagulants (DOACs) are widely used for the prevention and treatment of thromboembolic disease and have streamlined long-term anticoagulation management due to fixed dosing. However, in time-sensitive clinical scenarios such as acute ischemic stroke, major bleeding, and perioperative care, uncertainty regarding anticoagulant effect can complicate decision-making, such as treatment with thrombolytic and/or reversal agents. Objectives This review summarizes the limitations of existing measurement strategies, outlines key clinical scenarios where rapid assessment may inform care, and evaluates the potential role of point-of-care testing in improving safety and decision-making in hyperacute anticoagulation management. Methods We assessed literature evaluating laboratory and point-of-care methods for assessing DOAC activity, with emphasis on their application in clinical settings, including acute ischemic stroke, major bleeding, and perioperative management. Results Current laboratory approaches to assess DOAC activity, including routine coagulation tests and DOAC-specific assays, are limited by variable sensitivity, limited availability, delayed turnaround times, and lack of validated therapeutic thresholds to guide management. As a result, clinicians must make decisions without reliable, timely information on anticoagulant status. Emerging point-of-care technologies offer the potential to address this gap by providing rapid, clinically actionable insights into DOAC presence and effect. Conclusion Rapid measurement of DOAC activity has the potential to improve clinical decision-making in time-sensitive scenarios involving patients receiving DOAC therapy. Future efforts should focus on integrating these approaches into clinical practice and evaluating their impact on patient-centered outcomes.