Direct oral anticoagulant monitoring: what laboratory tests are available to guide us?

Direct oral anticoagulant monitoring: what laboratory tests are available to guide us? Hematology Am Soc Hematol Educ Program. 2019 Dec 06;2019(1):194-197 Authors: Sarode R Abstract Direct oral anticoagulants (DOACs) are increasingly used in the treatment and prophylaxis of thromboembolism because of several advantages over vitamin K antagonists, including no need for laboratory monitoring. However, it has become increasingly important in certain clinical scenarios to know either actual DOAC concentration (quantitative) or presence of DOAC (qualitative). These clinical conditions include patients presenting with major bleeding or requiring urgent surgery who may need a reversal or hemostatic agent, extremes of body weight, failed therapy, etc. Prothrombin time and activated partial thromboplastin time are variably affected by factor Xa inhibitors (FXaIs) and direct thrombin inhibitor (DTI), respectively, depending on reagents' sensitivity, and hence, they cannot be relied on confidently. Thrombin time is highly sensitive to very low amounts of DTI; thus, normal value rules out a clinically significant amount. Liquid chromatography mass spectrometry accurately measures DOAC levels but is clinically impractical. Dilute thrombin time and ecarin-based assays using appropriate calibrators/controls provide an accurate DTI level. Anti-Xa assay using corresponding FXaI calibrators/controls provides accurate drug levels. However, these assays are not readily avail...
Source: Hematology ASH Education Program - Category: Hematology Tags: Hematology Am Soc Hematol Educ Program Source Type: research

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Authors: Bharadwaj AS, Swamy PM, Mamas MA Abstract Introduction: There are numerous shared risk factors in the etiopathogenesis of coronary artery disease (CAD) and cancer both at the epidemiologic and molecular level. Additionally, the different modalities of treatment of cancer such as radiation, chemotherapy, immunotherapy and hormonal therapies further increase the risk of CAD and acute coronary syndrome. Most large database analysis and single center experiences have shown that cancer patients undergoing PCI are at an increased risk of in-hospital mortality, bleeding repeat revascularization.Areas covered: In ...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
In conclusion, to patients with thrombosis complicated by decreased fibrinogen level, clinicians and laboratory physicians should be alert to the possibility of congenital dysfibrinogenemia.
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
AbstractThe parenterally administered direct thrombin inhibitors (DTIs) argatroban and bivalirudin are effective anticoagulants for acute heparin-induced thrombocytopenia (HIT) treatment. The activated partial thromboplastin time (aPTT) has classically been used as the monitoring test to assess degree of anticoagulation, however concerns exist with using aPTT to monitor DTI therapy. In this observational study plasma samples from DTI treated patients were analyzed by aPTT, dilute thrombin time (dTT) and ecarin chromogenic assay (ECA) to delineate results into concordant and discordant groups. Discordant samples were furthe...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Adjusting the doses of enoxaparin based on anti-Xa levels, instead of using standard doses, may better prevent venous thromboembolism (VTE) without worsening bleeding rates in patients undergoing abdominal cancer surgery, according to a new study.Reuters Health Information
Source: Medscape General Surgery Headlines - Category: Surgery Tags: General Surgery News Source Type: news
AbstractIntroductionThe study was conducted to assess the safety and efficacy of a combined oral contraceptive, YAZ, containing 3  mg drospirenone/20 μg ethinyl estradiol administered in a 24/4 regimen.MethodsThis was a single-arm, open-label, interventional, post-authorization safety surveillance study of YAZ across 6 treatment cycles. Primary objective was assessing its safety profile in Chinese women. Secondary objectives included assessing contraceptive efficacy, cycle control, and bleeding patterns among subjects with and without preceding abortion, along with efficacy in moderate acne vulgaris. Subgroup ...
Source: Advances in Therapy - Category: Drugs & Pharmacology Source Type: research
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Source: Arteriosclerosis, Thrombosis and Vascular Biology - Category: Cardiology Authors: Tags: Arterioscler Thromb Vasc Biol Source Type: research
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Source: Arteriosclerosis, Thrombosis and Vascular Biology - Category: Cardiology Authors: Tags: Arterioscler Thromb Vasc Biol Source Type: research
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Source: Thrombosis Research - Category: Hematology Authors: Tags: Review Article Source Type: research
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Source: Frontiers in Neurology - Category: Neurology Source Type: research
CONCLUSION:  Moderate quality evidence suggests lower INR targets reduce bleeding but increase thromboembolism in AF. The data are dominated by East-Asian studies, limiting generalizability to Western populations. Until higher quality data demonstrate otherwise, an INR range of 2 to 3 should remain standard for thromboembolic prophylaxis in AF. PMID: 31940677 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
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