Abstract

CERESETTO, José Manuel. New direct oral anticoagulants, a paradigm shift in haemostasis assays. Acta bioquím. clín. latinoam. [online]. 2016, vol.50, n.2, pp.181-192. ISSN 0325-2957.

New oral direct anticoagulants (DOACs) are synthetic agents targeting either thrombin or factor Xa. Their predictable pharmacokinetics and scarce variability eliminate the need for regular coagulation monitoring. This is a paradigm shift in anticoagulation treatment. However, DOACs interfere with coagulation assays and it is very important to recognize them in a bleeding or thrombotic event or in an urgent surgery. Commonly used screening coagulation tests are of limited utility and different test reagents, what kind of test to perform for each anticoagulant and the time of drug intake must be considered. Specific assays can accurately quantify drug levels, but they are not yet related to clinical events and there is great inter-individual variability. As a conclusion,there are no laboratory assays developed to support dose adjustment based on these test results. New clinical trials with laboratory measurement will help solve this. Until then, this new paradigm of no laboratory testing in routine clinical practice will have to be accepted.

Keywords : New direct oral anticoagulants; Laboratory testing; Monitoring; Paradigm shift.