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Semin Thromb Hemost 2021; 47(02): 150-160
DOI: 10.1055/s-0041-1723770
Review Article

Direct Oral Anticoagulants Plasma Levels Measurement: Clinical Usefulness from Trials and Real-World Data

Francesca Renon
1   Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli” Monaldi Hospital, Naples, Italy
,
Anna Rago
2   Department of Cardiology, Monaldi Hospital, Naples, Italy
,
Biagio Liccardo
2   Department of Cardiology, Monaldi Hospital, Naples, Italy
,
Antonello D'Andrea
3   Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore, Italy
,
Lucia Riegler
3   Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore, Italy
,
Paolo Golino
1   Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli” Monaldi Hospital, Naples, Italy
,
Gerardo Nigro
1   Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli” Monaldi Hospital, Naples, Italy
,
Vincenzo Russo
1   Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli” Monaldi Hospital, Naples, Italy
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Abstract

Measurement of direct oral anticoagulants (DOACs) activity is not routinely necessary. Indeed, evaluation of DOACs plasmatic concentration is discouraged for the majority of patients, due to the lack of outcome data supporting this approach. Nevertheless, DOAC measurements may be useful in emergency situations such as serious bleeding events, need for urgent invasive procedures, and acute ischemic stroke or in managing anticoagulation in “special populations” not adequately studied in clinical trials, for example the very elderly or those at the extremes of body weight. The aim of this review is to describe and summarize the methods for DOACs activity evaluation and the settings in which their plasma level measurement may be indicated, analyzing indications from scientific societies and evidence from clinical trials, as well as real world data on the usefulness of DOACs plasma levels “monitoring.”

Keywords

direct oral anticoagulants - plasma level measurements - coagulation assays - elective procedures - extreme body weight - elderly


Publication History

Article published online:
26 February 2021

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