Direct oral anticoagulants – perspectives of therapeutic drug monitoring

Czech version

Authors: K. Urbánek
Authors‘ workplace: Ústav farmakologie, LF UP a FN Olomouc
Published in: Kardiol Rev Int Med 2015, 17(1): 76-81
Category: Internal Medicine

Overview

Direct oral anticoagulants (DOACs) are agents that have recently been introduced into clinical practice to replace warfarin. In addition to improved efficacy and safety, one of the anticipated benefits was the absence of the need for regular monitoring of coagulation parameters with the necessity of adjusting the doses on the basis of the obtained results. However, increasing need for quantitative determination of these substances in plasma in specific cases has been found. The gold standard for the essay of DOACs’ plasma concentrations is the LC‑ MS method. In daily practice, the use of indirect methods such as dTT for inhibitors of thrombin and chromogenic determination of anti‑Xa for factor Xa inhibitors is more usual. So far, it has not been recommended for any DOAC that therapeutic drug monitoring should be performed repeatedly for dosage adjustment. Plasma concentrations measurements are used in cases such as suspected noncompliance, bleeding complications during treatment, the need for acute thrombolysis or surgical procedures.

Keywords:
direct oral anticoagulants – therapeutic drug monitoring – dabigatran – rivaroxaban – apixaban

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