title: Direct Oral Anticoagulants: Monitoring Anticoagulant Effect.
abstract: In some clinical settings laboratory measurement of direct oral anticoagulants effect is helpful in guiding medical care, such as life-threatening bleeding, need for emergency surgery, renal impairment, severe hepatic failure, extremes of body weight, or in patients with bleeding or thrombosis on therapy. This article reviews approaches to laboratory testing to assess the anticoagulant effect of these drugs. Because of the wide variation in levels measured in patients on therapy and minimal clinical data from dose adjustment, dose adjustment based on levels is not currently advised. In addition, these drugs interfere with many clot-based laboratory tests and caution is advised in interpreting these tests in patients on direct oral anticoagulants.
authors.affiliation: Clinical and Translational Research, Hemostasis, Platelet Immunology, and Genomics Laboratory, Bloodworks Northwest, University of Washington School of Medicine, 921 Terry Avenue, Seattle, WA 98104, USA. Electronic address: BarbaraK@BloodworksNW.org.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Konkle
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000493:pharmacokinetics / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood / Q000601:surgery; D051437:Renal Insufficiency / Q000097:blood / Q000601:surgery; D013927:Thrombosis / Q000097:blood / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: Anticoagulant effect; Coagulation testing; Oral anticoagulants; Trough level