Laboratory testing of anticoagulants: the present and the future

Laboratory Assessment of Novel Oral Anticoagulants: Method Suitability and Variability between Coagulation Laboratories

“…Some fatal and major bleeds have been associated with high plasma concentrations of Dabi, especially with renal impairment (5,6 ). The effect of NOACs has not been studied in many other coinciding clinical conditions with increased bleeding diathesis, e.g., anemia, thrombocytopenia, or liver failure (7,8 ).…”

Managing New Oral Anticoagulants in the Perioperative and Intensive Care Unit Setting

“…31 More recently, a specific assay has been developed for the direct Xa inhibitors that is different from an antiXa assay used to monitor low-molecular-weight heparin, and may provide the optimal method for determining the effect of rivaroxaban, although further studies are needed. 2,32,33 Rivaroxaban produces a concentration-dependent prolongation of clotting parameters on thromboelastometry, including R and K time without significant modification of maximal amplitude, making this assay not useful for routine monitoring. 31 Until now, the lack of readily available means for assessing the degree of anticoagulation remains a notable concern, especially in a life-threatening bleed where point-of-care monitoring or rapid laboratory assays might be required.…”

Laboratory hemostasis: milestones in Clinical Chemistry and Laboratory Medicine

“…Thrombin generation assays [23,24] along with thromboelastography [25,26] are additional useful " global " tests of hemostasis, which have not found, however, widespread application in clinical and laboratory practice. Second line assays are typically those designed to provide further insights into abnormalities of screening tests, or used to monitor more accurately some antithrombotic therapies, and thereby include clotting factors assays [27] , ristocetin-induced platelet agglutination and VWF antigen tests [28] , anticardiolipin (aCL) IgG and IgM, anti-β (2) glycoprotein I (anti-β (2) GPI) antibodies IgG and IgM and phospholipid-dependent coagulation assays [29,30] , platelet function tests such as Platelet Function Analyzer-100 (PFA-100) and aggregometry [31,32] , assays for heparin-induced thrombocytopenia [33,34] , additional tests for thrombophilia screening including resistance to activated protein C, antithrombin, proteins C and S, and genetic polymorphisms/mutations (e.g., prothrombin G20210A and factor V Leiden) [35,36] along with ecarin clotting time, chromogenic anti-factor Xa and dilute Russell viper venom time (dRVVT) for monitoring novel anticoagulants [37,38] . Both first and second line tests might be available to most clinical laboratories, whereas third line tests -which are intended to troubleshoot the most challenging conditions and encompass analyses such as VWF collagen binding, VWF ristocetin cofactor assay, VWF-FVIII binding assay, multimer and molecular analysis for the precise classification of VWD [39,40] , coagulation factors inhibitors testing [41,42] , analyses of rare thrombophilic mutations [43] , rare platelet functional disorders [44] , pharmacogenetics testing [45,46] -are occasionally used and typically available in specialized laboratories.…”