Laboratory monitoring of anticoagulation: where do we stand?
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.
Tripodi
Armando
A
Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine, University Medical School and IRCCS Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy. armando.tripodi@unimi.it
van den Besselaar
Antonius
A
D000925:Anticoagulants / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000502:physiology*; D002986:Clinical Trials as Topic; D000077425:Fondaparinux; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D019934:International Normalized Ratio; D008991:Monitoring, Physiologic / Q000379:methods; D009025:Morpholines / Q000627:therapeutic use; D011134:Polysaccharides / Q000627:therapeutic use; D011517:Prothrombin Time; D011655:Pulmonary Embolism / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D000069552:Rivaroxaban; D013876:Thiophenes / Q000627:therapeutic use; D054556:Venous Thromboembolism / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D020246:Venous Thrombosis / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D014812:Vitamin K / Q000037:antagonists & inhibitors
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D009025:Morpholines; D011134:Polysaccharides; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D014812:Vitamin K; C522181:apixaban; D006493:Heparin; D000069552:Rivaroxaban; D000077425:Fondaparinux