title: [Monitoring of NOAC].
abstract: BACKGROUND
  Monitoring non-vitamin K antagonist oral anticoagulants (NOAC) is usually not necessary; however, in some patients it may prove beneficial.
  
  
  OBJECTIVE
  Patient subgroups who may profit from monitoring were identified, and methods of monitoring (including assessment of which coagulation parameters are affected by NOAC) are described.
  
  
  METHODS
  We searched the PubMed database for each of the search terms, "NOAC", "DOAC", "rivaroxaban", "dabigatran", and "apixaban", in combination with one of the terms, "monitoring", "measurement", "measuring", or "assessment". The results were compiled and reviewed.
  
  
  RESULTS
  Monitoring is most advantageous in emergency cases with severe bleeding where drug activity needs to be assessed. It can also help in deciding for or against lysis therapy after acute stroke in patients taking NOAC. Furthermore, it can also identify compliance problems and help in planning periprocedural management. There are quantitative measurement methods which measure plasma concentrations exactly and qualitative methods which only allow for a rough estimate or a general confirmation of drug activity. Recommended quantitative measurement methods are diluted thrombin time for dabigatran, and anti-factor Xa activity (calibrated) for rivaroxaban and apixaban.
  
  
  CONCLUSIONS
  Several patient subgroups may profit from monitoring of NOAC plasma concentration. One should, however, take several issues into consideration before measurements, such as the objective of each individual measurement, possible consequences (e. g., dose adjustment), and which measurement method to pick.
authors.affiliation: Institut für Laboratoriumsmedizin & Transfusionsmedizin, LBT Zotz/Klimas, Immermannstraße 65a, 40210, Düsseldorf, Deutschland. zotz@zotzklimas.de.
authors.forename: R B
authors.initials: RB
authors.lastname: Zotz
authors.affiliation: Institut für Laboratoriumsmedizin & Transfusionsmedizin, LBT Zotz/Klimas, Immermannstraße 65a, 40210, Düsseldorf, Deutschland.
authors.forename: L
authors.initials: L
authors.lastname: Weißbach
mesh_terms: D000284:Administration, Oral; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D000925:Anticoagulants / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D000069604:Dabigatran / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D004636:Emergency Service, Hospital; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced; D006801:Humans; D007362:Intensive Care Units; D011720:Pyrazoles / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D011728:Pyridones / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D020521:Stroke / Q000097:blood* / Q000188:drug therapy*; D013923:Thromboembolism / Q000097:blood / Q000188:drug therapy*; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; D014812:Vitamin K; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Apixaban; Dabigatran; Drug monitoring; Factor Xa inhibitors; Rivaroxaban