Welcome to Ask Stago, the podcast dedicated to provide expert answers to your expert questions in hemostasis. 

In today episode, our expert guest, Jonathan Douxfils, CEO at QUALIblood SA and Professor at the University of Namur / Department of Pharmacy, will detail with us the current recommendation on how to measure direct oral anticoagulants and in which clinical situation this information is relevant and useful..  

As usual, don’t forget to send any question you may have to ask@stago.com, we will be glad to answer to it. 

Learn more - Literature sources: 

• Bernier M, Lancrerot SL, Parassol N, Lavrut T, Viotti J, Rocher F, Drici MD. Therapeutic Drug Monitoring of Direct Oral Anticoagulants May Increase Their Benefit-Risk Ratio. J Cardiovasc Pharmacol. 2020 Oct;76(4):472-477. Epub 2020/10/09. doi:10.1097/FJC.0000000000000870. Cited in: Pubmed; PMID 33030858. 
• Douxfils J, Ageno W, Samama CM, Lessire S, Ten Cate H, Verhamme P, Dogne JM, Mullier F. Laboratory testing in patients treated with direct oral anticoagulants: a practical guide for clinicians. Journal of thrombosis and haemostasis : JTH. 2018 Feb;16(2):209-219. Epub 2017/12/02. doi:10.1111/jth.13912. Cited in: Pubmed; PMID 29193737. 
• Douxfils J, Mullier F, Dogne JM. Dose tailoring of dabigatran etexilate: obvious or excessive? Expert Opin Drug Saf. 2015 Aug;14(8):1283-9. Epub 2015/05/23. doi:10.1517/14740338.2015.1049995. Cited in: Pubmed; PMID 25994994. 
• Gosselin RC, Adcock DM, Bates SM, Douxfils J, Favaloro EJ, Gouin-Thibault I, Guillermo C, Kawai Y, Lindhoff-Last E, Kitchen S. International Council for Standardization in Haematology (ICSH) Recommendations for Laboratory Measurement of Direct Oral Anticoagulants. Thrombosis and haemostasis. 2018 Mar;118(3):437-450. Epub 2018/02/13. doi:10.1055/s-0038-1627480. Cited in: Pubmed; PMID 29433148. 
• Gosselin RC, Adcock DM, Douxfils J. An update on laboratory assessment for direct oral anticoagulants (DOACs). International journal of laboratory hematology. 2019 May;41 Suppl 1(00):33-39. Epub 2019/05/10. doi:10.1111/ijlh.12992. Cited in: Pubmed; PMID 31069969. 
• Spyropoulos AC, Al-Badri A, Sherwood MW, Douketis JD. To measure or not to measure direct oral anticoagulants before surgery or invasive procedures: comment. Journal of thrombosis and haemostasis : JTH. 2016 Dec;14(12):2556-2559. Epub 2016/10/25. doi:10.1111/jth.13505. Cited in: Pubmed; PMID 27622661. 
• Tripodi A. To measure or not to measure direct oral anticoagulants before surgery or invasive procedures: reply. Journal of thrombosis and haemostasis : JTH. 2016 Dec;14(12):2559-2561. Epub 2016/10/25. doi:10.1111/jth.13513. Cited in: Pubmed; PMID 27662099. 
• Tripodi A. To measure or not to measure direct oral anticoagulants before surgery or invasive procedures. Journal of thrombosis and haemostasis : JTH. 2016 Jul;14(7):1325-7. Epub 2016/04/21. doi:10.1111/jth.13344. Cited in: Pubmed; PMID 27094864 
• Douxfils J, Adcock DM, Bates SM, Favaloro EJ, Gouin-Thibault I, Guillermo C, Kawai Y, Lindhoff-Last E, Kitchen S, Gosselin RC. 2021 Update of the International Council for Standardization in Haematology Recommendations for Laboratory Measurement of Direct Oral Anticoagulants. Thrombosis and haemostasis. 2021 Mar 19. Epub 2021/03/21. doi:10.1055/a-1450-8178. Cited in: Pubmed; PMID 33742436. 
• Reilly PA, Lehr T, Haertter S, Connolly SJ, Yusuf S, Eikelboom JW, Ezekowitz MD, Nehmiz G, Wang S, Wallentin L, Investigators R-L. The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in atrial fibrillation patients: the RE-LY Trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). Journal of the American College of Cardiology. 2014 Feb 4;63(4):321-8. Epub 2013/10/01. doi:10.1016/j.jacc.2013.07.104. Cited in: Pubmed; PMID 24076487. 
• Ruff CT, Giugliano RP, Braunwald E, Morrow DA, Murphy SA, Kuder JF, Deenadayalu N, Jarolim P, Betcher J, Shi M, Brown K, Patel I, Mercuri M, Antman EM. Association between edoxaban dose, concentration, anti-Factor Xa activity, and outcomes: an analysis of data from the randomised, double-blind ENGAGE AF-TIMI 48 trial. The Lancet. 2015;385(9984):2288-2295. doi:10.1016/s0140-6736(14)61943-7. 
• Eikelboom JW, Quinlan DJ, Hirsh J, Connolly SJ, Weitz JI. Laboratory Monitoring of Non-Vitamin K Antagonist Oral Anticoagulant Use in Patients With Atrial Fibrillation: A Review. JAMA Cardiol. 2017 May 1;2(5):566-574. Epub 2017/03/30. doi:10.1001/jamacardio.2017.0364. Cited in: Pubmed; PMID 28355459. 
• Bouget J, Oger E. Emergency admissions for major haemorrhage associated with direct oral anticoagulants. Thrombosis research. 2015 Dec;136(6):1190-4. Epub 2015/11/08. doi:10.1016/j.thromres.2015.10.036. Cited in: Pubmed; PMID 26545315. 
• Pollack CV, Jr., Reilly PA, van Ryn J, Eikelboom JW, Glund S, Bernstein RA, Dubiel R, Huisman MV, Hylek EM, Kam CW, Kamphuisen PW, Kreuzer J, Levy JH, Royle G, Sellke FW, Stangier J, Steiner T, Verhamme P, Wang B, Young L, Weitz JI. Idarucizumab for Dabigatran Reversal - Full Cohort Analysis. The New England journal of medicine. 2017 Aug 3;377(5):431-441. Epub 2017/07/12. doi:10.1056/NEJMoa1707278. Cited in: Pubmed; PMID 28693366. 
• Sennesael AL, Larock AS, Douxfils J, Elens L, Stillemans G, Wiesen M, Taubert M, Dogne JM, Spinewine A, Mullier F. Rivaroxaban plasma levels in patients admitted for bleeding events: insights from a prospective study. Thrombosis journal. 2018;16:28. Epub 2018/11/21. doi:10.1186/s12959-018-0183-3. Cited in: Pubmed; PMID 30455596. 
• Testa S, Legnani C, Antonucci E, Paoletti O, Dellanoce C, Cosmi B, Pengo V, Poli D, Morandini R, Testa R, Tripodi A, Palareti G, Coordinator of SR. Drug levels and bleeding complications in atrial fibrillation patients treated with direct oral anticoagulants. Journal of thrombosis and haemostasis : JTH. 2019 Jul;17(7):1064-1072. Epub 2019/04/24. doi:10.1111/jth.14457. Cited in: Pubmed; PMID 31013383. 
• Testa S, Paoletti O, Legnani C, Dellanoce C, Antonucci E, Cosmi B, Pengo V, Poli D, Morandini R, Testa R, Tripodi A, Palareti G. Low drug levels and thrombotic complications in high-risk atrial fibrillation patients treated with direct oral anticoagulants. Journal of thrombosis and haemostasis : JTH. 2018 May;16(5):842-848. Epub 2018/03/14. doi:10.1111/jth.14001. Cited in: Pubmed; PMID 29532628. 
• Suwa M, Morii I, Kino M. Rivaroxaban or Apixaban for Non-Valvular Atrial Fibrillation- Efficacy and Safety of Off-Label Under-Dosing According to Plasma Concentration. Circ J. 2019 Apr 25;83(5):991-999. Epub 2019/03/29. doi:10.1253/circj.CJ-18-1282. Cited in: Pubmed; PMID 30918237. 
• Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, Oldgren J, Reinecke H, Roldan-Schilling V, Rowell N, Sinnaeve P, Vanassche T, Potpara T, Camm AJ, Heidbuchel H, External r, Lip GYH, Deneke T, Dagres N, Boriani G, Chao TF, Choi EK, Hills MT, Santos IS, Lane DA, Atar D, Joung B, Cole OM, Field M. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2021 Apr 25. Epub 2021/04/26. doi:10.1093/europace/euab065. Cited in: Pubmed; PMID 33895845. 
• Seiffge DJ, Traenka C, Polymeris AA, Thilemann S, Wagner B, Hert L, Muller MD, Gensicke H, Peters N, Nickel CH, Stippich C, Sutter R, Marsch S, Fisch U, Guzman R, De Marchis GM, Lyrer PA, Bonati LH, Tsakiris DA, Engelter ST. Intravenous Thrombolysis in Patients with Stroke Taking Rivaroxaban Using Drug Specific Plasma Levels: Experience with a Standard Operation Procedure in Clinical Practice. J Stroke. 2017 Sep;19(3):347-355. Epub 2017/09/08. doi:10.5853/jos.2017.00395. Cited in: Pubmed; PMID 28877563. 
• Steiner T, Bohm M, Dichgans M, Diener HC, Ell C, Endres M, Epple C, Grond M, Laufs U, Nickenig G, Riess H, Rother J, Schellinger PD, Spannagl M, Veltkamp R. Recommendations for the emergency management of complications associated with the new direct oral anticoagulants (DOACs), apixaban, dabigatran and rivaroxaban. Clin Res Cardiol. 2013 Jun;102(6):399-412. Epub 2013/05/15. doi:10.1007/s00392-013-0560-7. Cited in: Pubmed; PMID 23669868. 
• Levy JH, Ageno W, Chan NC, Crowther M, Verhamme P, Weitz JI, Subcommittee on Control of A. When and how to use antidotes for the reversal of direct oral anticoagulants: guidance from the SSC of the ISTH. Journal of thrombosis and haemostasis : JTH. 2016 Mar;14(3):623-7. Epub 2016/02/26. doi:10.1111/jth.13227. Cited in: Pubmed; PMID 26911798. 
• Martin K, Beyer-Westendorf J, Davidson BL, Huisman MV, Sandset PM, Moll S. Use of the direct oral anticoagulants in obese patients: guidance from the SSC of the ISTH. Journal of thrombosis and haemostasis : JTH. 2016 Jun;14(6):1308-13. Epub 2016/06/15. doi:10.1111/jth.13323. Cited in: Pubmed; PMID 27299806. 
• Piran S, Traquair H, Chan N, Bhagirath V, Schulman S. Peak plasma concentration of direct oral anticoagulants in obese patients weighing over 120 kilograms: A retrospective study. Res Pract Thromb Haemost. 2018 Oct;2(4):684-688. Epub 2018/10/24. doi:10.1002/rth2.12146. Cited in: Pubmed; PMID 30349887. 
• Siriez R, Dogne JM, Gosselin R, Laloy J, Mullier F, Douxfils J. Comprehensive review of the impact of direct oral anticoagulants on thrombophilia diagnostic tests: Practical recommendations for the laboratory. International journal of laboratory hematology. 2021 Feb;43(1):7-20. Epub 2020/09/19. doi:10.1111/ijlh.13342. Cited in: Pubmed; PMID 32946681. 
   

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Content is scientific and technical in nature. It is intended as an educational tool for laboratory professionals and topics discussed are not intended as recommendations or as commentary on appropriate clinical practice.