Chest
Original Research: Antithrombotic TherapyLaboratory Assessment of the Anticoagulant Activity of Direct Oral Anticoagulants: A Systematic Review
Section snippets
Literature Search
We performed a systematic review of the literature to examine use of coagulation assays for assessment of the anticoagulant activity of DOACs. A search of PubMed, Web of Science, and Embase from inception through July 1, 2015, was undertaken for dabigatran, rivaroxaban, apixaban, and edoxaban using the key words “name of drug” AND (monitoring OR measurement OR laboratory OR prothrombin time OR partial thromboplastin time OR activated partial thromboplastin time OR PT OR APTT). For anti-Xa
Dabigatran
Dabigatran etexilate is taken orally as an inactive nonpeptide prodrug and is rapidly converted by nonspecific esterases to a potent, direct inhibitor of free- and fibrin-bound thrombin. Absorption is rapid, but bioavailability is only 6.5%. The half-life is 12 to 14 hours, and elimination is 80% renal.13 The expected steady-state concentrations of dabigatran as measured by LC-MS/MS are shown in Table 1.
Discussion
Although there are no established therapeutic ranges for any of these drugs or evidence to support routine monitoring with or without titration of dose, there are a variety of circumstances in which assessing anticoagulant effect may be useful. A number of professional societies, including the ISTH and CHEST, have published recommendations for urgent or routine assessment of the anticoagulant effects of direct thrombin inhibitors and anti-Xa agents. In this systematic review, we have examined
Acknowledgments
Author contributions: B. T. S., had full access to all the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis. A. C., D. M. S., M. C., and D. A. G. contributed substantially to the study design, data analysis and interpretation, and writing of the manuscript.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: A. C. has served as a consultant for Amgen, Bracco, and Genzyme and has received research
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FUNDING/SUPPORT: This research was supported in part by the National Heart, Lung, and Blood Institute [T32HL007093].