The advantages of DOACs compared with vitamin K antagonists (VKAs) are a more favorable bleeding profile, limited food, and drug interactions, and they do not require routine monitoring, except under some specific conditions. This class of medication consists of the direct thrombin (FIIa) inhibitor (dabigatran) or direct factor Xa (FXa) inhibitors (apixaban, rivaroxaban, edoxaban, and betrixaban). This review provides a short summary of DOAC properties and an update on laboratory methods for measuring DOACs.ĭirect oral anticoagulants (DOACs) constitute first-line therapy used for many thromboembolic indications, such as prevention and treatment of venous thromboembolism (VTE) and stroke prevention in atrial fibrillation (AF). The general consensus for the assessment of a DOAC is clotting or chromogenic assays using specific standard calibrators and controls. Liquid chromatography–mass spectrometry (LC-MS/MS) is considered the gold standard method for DOAC measurement, but it is time consuming and requires expensive equipment. The effect of DOACs on the screening coagulation assays such as prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT) is directly linked to reagent composition, and clotting time can be different from reagent to reagent, depending on the DOAC’s reagent sensitivity. However in specific clinical situations and for particular patient populations, testing may be helpful for patient management. Because DOACs have predictable pharmacokinetic and pharmacodynamic responses at a fixed dose, they do not require monitoring. The short half-life of a DOAC constrains the daily oral intake.

The coagulation effect follows the plasma concentration–time profile of the respective anticoagulant.

DOACs directly, selectively, and reversibly inhibit factors IIa or Xa. The introduction of direct oral anticoagulants (DOACs), such as dabigatran, rivaroxaban, apixaban, edoxaban, and betrixaban, provides safe and effective alternative to previous anticoagulant therapies.

Pradaxa bind