Laboratory monitoring of new anticoagulants.
Maintaining a balance between bleeding and clotting has always been a challenge in treating coagulation disorders. A perturbation in that balance can be associated with substantial morbidity and mortality. As a result, anticoagulant monitoring is extremely important, and inappropriate testing may lead to complications. There are now a variety of new anticoagulant drugs in clinical use including several direct thrombin inhibitors (DTIs), such as argatroban, bivalirudin, and hirudin, as well as a Factor Xa inhibitor, fondaparinux. There are pitfalls associated with some of the currently used laboratory monitoring tests, and newer alternative laboratory monitoring tests have been investigated (Walenga and Hoppensteadt, Semin Thromb Hemost 2004;30:683-695). In addition, laboratory testing can assist with transitioning patients from DTI to warfarin therapy.
Castellone
Donna D
DD
Clinical Project Manager Hemostasis/Hematology, Medical, Clinical and Statistical Affairs, Siemens Healthcare Diagnostics, Tarrytown, New York, USA. donna.castellone@siemens.com
Van Cott
Elizabeth M
EM
D000925:Anticoagulants / Q000145:classification / Q000494:pharmacology* / Q000627:therapeutic use; D001120:Arginine / Q000031:analogs & derivatives; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests; D002863:Chromogenic Compounds; D016903:Drug Monitoring / Q000379:methods*; D065427:Factor Xa Inhibitors; D006801:Humans; D010875:Pipecolic Acids / Q000494:pharmacology / Q000627:therapeutic use; D013449:Sulfonamides; D013917:Thrombin / Q000037:antagonists & inhibitors; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D002863:Chromogenic Compounds; D065427:Factor Xa Inhibitors; D010875:Pipecolic Acids; D013449:Sulfonamides; D014859:Warfarin; D001120:Arginine; D013917:Thrombin; C031942:argatroban