Clinical pearls: Laboratory assessments of direct oral anticoagulants (DOACS)

Robert C. Gosselin; Jonathan Douxfils; Dorothy Adcock

doi:10.5482/HAMO-17-01-0002

Hämostaseologie, Inhaltsverzeichnis

Hamostaseologie 2017; 37(04): 295-301
DOI: 10.5482/HAMO-17-01-0002

Review

Schattauer GmbH

Clinical pearls: Laboratory assessments of direct oral anticoagulants (DOACS)

Laborbeurteilung von direkten oralen Antikoagulanzien (DOAKs)

Robert C. Gosselin

¹University of California, Davis Health System, Pathology and Laboratory Medicine, Sacramento, California, United States

,

Jonathan Douxfils

²Université de Namur, Pharmacy, Namur, Belgium

,

Dorothy Adcock

³Laboratory Corporation of America® Holdings – Colorado Coagulation, Englewood, Colorado, United States

› Institutsangaben

Abstract

Summary

Direct oral anticoagulants (DOACS) are being used for stroke prevention in patients with atrial fibrillation as well as for prophylaxis and treatment of venous thromboembolism. Clinicians who treat, or may encounter, patients with DOAC exposure, should be aware of the limitations of coagulation testing in this setting, and seek counsel from their laboratory to understand the effects of DOACS on coagulation results. Generally, assays that employ clot based principles, or methods that require thrombin or Factor Xa activation or substrates may be affected by the presence of DOACS. The clinical laboratory should have an algorithmic testing plan for adequately assessing the presence of all DOACS and readily provide this information to clinicians. We describe Clinical Pearls for DOAC assessment using common and esoteric coagulation testing.

Zusammenfassung

Direkte orale Antikoagulanzien (DOAK) werden zur Schlaganfallprophylaxe bei Patienten mit Vorhofflimmern und zur Prophylaxe sowie Behandlung von venösen Thrombembolien eingesetzt. Ärzte, die Patienten unter DOAK-Therapie behandeln oder mit diesen konfrontiert werden, sollten sich über die Grenzen der Bestimmung der Gerinnungswerte unter diesen Bedingungen im Klaren sein. Sie sollten den Rat ihres Labors einholen, um die Wirkungen der DOAK auf die Gerinnungswerte richtig einzuschätzen. Generell können Assays, die auf funktionellen Clotting-Tests basieren, oder Methoden, die Thrombin oder Faktor Xa als Substrat verwenden bzw. deren Aktivierung erfordern, von DOAK beeinflusst werden. Das klinische Labor sollte über einen algorithmischen Testplan verfügen, um die Präsenz aller DOAK in geeigneter Weise zu beurteilen und den Ärzten diese Informationen umgehend zur Verfügung stellen zu können. Wir beschreiben klinische Perlen für die DOAK-Untersuchung anhand der üblichen Gerinnungstests wie auch selteneren Verfahren.

Keywords

Dabigatran - rivaroxaban - apixaban - edoxaban - direct oral anticoagulants

Schlüsselwörter

Dabigatran - Rivaroxaban - Apixaban - Edoxaban - direkte orale Antikoagulanzien

Volltext

Referenzen

References
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