title: Non-VKA Oral Anticoagulants: Accurate Measurement of Plasma Drug Concentrations.
abstract: Non-VKA oral anticoagulants (NOACs) have now widely reached the lucrative market of anticoagulation. While the marketing authorization holders claimed that no routine monitoring is required and that these compounds can be given at fixed doses, several evidences arisen from the literature tend to demonstrate the opposite. New data suggests that an assessment of the response at the individual level could improve the benefit-risk ratio of at least dabigatran. Information regarding the association of rivaroxaban and apixaban exposure and the bleeding risk is available in the drug approval package on the FDA website. These reviews suggest that accumulation of these compounds increases the risk of experiencing a bleeding complication. Therefore, in certain patient populations such as patients with acute or chronic renal impairment or with multiple drug interactions, measurement of drug exposure may be useful to ensure an optimal treatment response. More specific circumstances such as patients experiencing a haemorrhagic or thromboembolic event during the treatment duration, patients who require urgent surgery or an invasive procedure, or patient with a suspected overdose could benefit from such a measurement. This paper aims at providing guidance on how to best estimate the intensity of anticoagulation using laboratory assays in daily practice.
authors.affiliation: Department of Pharmacy, University of Namur, Namur Thrombosis and Haemostasis Center (NTHC), Namur Research Institute of Life Sciences (NARILIS), 5000 Namur, Belgium.
authors.forename: Jonathan
authors.identifier: 0000-0002-7644-5298
authors.initials: J
authors.lastname: Douxfils
authors.affiliation: Department of Haemostasis, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany.
authors.forename: Helen
authors.initials: H
authors.lastname: Mani
authors.affiliation: Department of Pharmacy, University of Namur, Namur Thrombosis and Haemostasis Center (NTHC), Namur Research Institute of Life Sciences (NARILIS), 5000 Namur, Belgium.
authors.forename: Valentine
authors.initials: V
authors.lastname: Minet
authors.affiliation: Department of Haematology, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Haemostasis Center (NTHC), Namur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium.
authors.forename: Bérangère
authors.initials: B
authors.lastname: Devalet
authors.affiliation: Haematology Laboratory, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Haemostasis Center (NTHC), Namur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: Chatelain
authors.affiliation: Department of Pharmacy, University of Namur, Namur Thrombosis and Haemostasis Center (NTHC), Namur Research Institute of Life Sciences (NARILIS), 5000 Namur, Belgium.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Dogné
authors.affiliation: Haematology Laboratory, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Haemostasis Center (NTHC), Namur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium.
authors.forename: François
authors.identifier: 0000-0001-6947-6099
authors.initials: F
authors.lastname: Mullier
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology*; D000069604:Dabigatran / Q000009:adverse effects / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced / Q000503:physiopathology*; D006801:Humans; D009025:Morpholines / Q000009:adverse effects / Q000627:therapeutic use; D011720:Pyrazoles / Q000009:adverse effects / Q000627:therapeutic use; D011728:Pyridones / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment; D000069552:Rivaroxaban / Q000009:adverse effects / Q000627:therapeutic use; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use; D013923:Thromboembolism
chemical_list: D000925:Anticoagulants; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran