The era of targeted monitoring thromboembolism and anti-coagulation therapy

Abstract

The emergence of new oral anticoagulant (NOAC) reduced the risk of venous thromboembolism recurrence and major bleeding, with their specificity on inhibiting single coagulation factor, hence avoided frequent dose adjustment of classic anticoagulant therapy. Recently, A new stage was initialed by several new assays with their approval of SFDA in clinical application, either providing a targeted assessment on targeted anticoagulation, or filling the gaps between measurement and evaluating progressive blood coagulation. Clinicians could take stratified way- global coagulation-effective dose of anticoagulant-thrombin generation-fibrin production to monitor and treat in the major axis of coagulation, eliminating the confusion of cross-network-like coagulation mechanism previously. In this paper, focusing on characteristics of new oral anticoagulants, we interpret the advantages of anti-activated factor Ⅱ and anti-activated factor Ⅹ activity in evaluating anticoagulant efficacy, and then suggest thrombin generation test and thrombin-antithrombin complex these two important parameters to understand the inhibitory action of NOAC, which reflect the degree of thrombin activation directly or indirectly. Moreover, fibrin monomer play a unique role in assessment of thrombin inhibition, as an early marker of fibrinogen formation. Potential value of factor ⅩⅢ in bleeding etiology is also discussed for its essentiality in the process of fibrin formation. Different from traditional coagulation tests determining the comprehensive activity of a variety of coagulation proteins, new assays provide information on activity or inhibition of a single target in anticoagulation therapy to analyze the anticoagulant effect or prognosis of thromboembolism accurately, which leads hemostasis and thrombosis tests into a new era.(Chin J Lab Med, 2017, 40: 766-769) Key words: Anticoagulants; Drug monitoring; Thrombin; Venous thromboembolism; Administration, oral