Abstract
Traditional anticoagulant agents such as vitamin K antagonists (VKAs), unfractionated heparin (UFH), low molecular weight heparins (LMWHs) and fondaparinux have been widely used in the prevention and treatment of thromboembolic diseases. However, these agents are associated with limitations, such as the need for regular coagulation monitoring (VKAs and UFH) or a parenteral route of administration (UFH, LMWHs and fondaparinux).Several non-VKA oral anticoagulants (NOACs) are now widely used in the prevention and treatment of thromboembolic diseases and in stroke prevention in non-valvular atrial fibrillation. Unlike VKAs, NOACs exhibit predictable pharmacokinetics and pharmacodynamics. They are therefore usually given at fixed doses without routine coagulation monitoring. However, in certain patient populations or special clinical circumstances, measurement of drug exposure may be useful, such as in suspected overdose, in patients experiencing a hemorrhagic or thromboembolic event during the treatment’s period, in those with acute renal failure, in patients who require urgent surgery or in case of an invasive procedure. This article aims at providing guidance on laboratory testing of classic anticoagulants and NOACs.Electronic supplementary materialThe online version of this article (doi:10.1186/1477-9560-12-24) contains supplementary material, which is available to authorized users.
Highlights
Anticoagulants are a mainstay of cardiovascular therapy and, until recently, vitamin K antagonists (VKAs) were the only oral anticoagulants available
Non-VKA oral anticoagulants will certainly replace some of the traditional anticoagulants in the future but it is important to keep in mind that the introduction of these new agents will change the strategies of patient management and of the hospital routine [21]
It is anticipated that a non-negligible proportion of patients will reach either insufficient or supra-therapeutic level when given at fixed dose leading to the introduction of dedicated coagulation tests that respond faithfully to the pharmacodynamics of non-VKA oral anticoagulants (NOACs)
Summary
Anticoagulants are a mainstay of cardiovascular therapy and, until recently, vitamin K antagonists (VKAs) were the only oral anticoagulants available. Recommendations advice to monitor the intensity of anticoagulation via the measurement of peak anti-Xa activity levels with various target ranges depending on the LMWH preparation and the frequency of dosing (Table 1) [78,120]. Global coagulation tests Dabigatran: activated Partial Thromboplastin Time The recent recommendation of the Subcommittee of Control of Anticoagulation of the Scientific and Standardisation Committee of the ISTH, mentions that the aPTT using most available reagents can be used to determine the relative intensity of anticoagulation due to dabigatran. They state that aPTT should not be used to quantify the drug plasma concentration.
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