Thomas Moner-Banet1, Lorenzo Alberio2, Pierre-Alexandre Bart3. 1. Department of Internal Medicine, Riviera-Chablais Hospital, Rennaz, Switzerland. 2. Division of Haematology and Central Haematology Laboratory, CHUV Lausanne University Hospital, University of Lausanne (UNIL), Lausanne, Switzerland. 3. Department of Internal Medicine, CHUV Lausanne University Hospital, University of Lausanne (UNIL), Lausanne, Switzerland.
Abstract
BACKGROUND: There is an increasing amount of literature on direct oral anticoagulant (DOAC) laboratory monitoring. The aims of the present review were to evaluate published data on monitoring DOACs, to provide clinical guidance on how to interpret results, and to summarize why, when, and how to monitor DOACs. METHODS: The publications screened for this review were obtained through a PubMed search for articles published in English or French before April 2019 that had the following as their main themes: DOAC monitoring, DOAC exposure-effect relationship, DOAC drug interactions, and pharmacokinetics and pharmacodynamics of DOACs. RESULTS: DOACs show important inter- and intrapersonal concentration variability and a significant exposure-effect relationship. Concentrations out of the expected range have been shown to lead to an increased adverse event rate and a lower efficacy. No definitive therapeutic range exists for DOACs except for dabigatran for which trough levels of 40 to 200 ng/mL seem to be the consensus. Indications to monitor include suspected drug accumulation in special patient populations, suspected drug failure, and acute situations such as hemorrhagic or thrombotic events. CONCLUSION: There is a likely benefit to monitor DOACs in order to improve their safety and efficacy but randomized controlled trials are required to determine the therapeutic range of these drugs and evaluate whether DOAC monitoring can improve outcomes in a clinical setting. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: There is an increasing amount of literature on direct oral anticoagulant (DOAC) laboratory monitoring. The aims of the present review were to evaluate published data on monitoring DOACs, to provide clinical guidance on how to interpret results, and to summarize why, when, and how to monitor DOACs. METHODS: The publications screened for this review were obtained through a PubMed search for articles published in English or French before April 2019 that had the following as their main themes: DOAC monitoring, DOAC exposure-effect relationship, DOAC drug interactions, and pharmacokinetics and pharmacodynamics of DOACs. RESULTS:DOACs show important inter- and intrapersonal concentration variability and a significant exposure-effect relationship. Concentrations out of the expected range have been shown to lead to an increased adverse event rate and a lower efficacy. No definitive therapeutic range exists for DOACs except for dabigatran for which trough levels of 40 to 200 ng/mL seem to be the consensus. Indications to monitor include suspected drug accumulation in special patient populations, suspected drug failure, and acute situations such as hemorrhagic or thrombotic events. CONCLUSION: There is a likely benefit to monitor DOACs in order to improve their safety and efficacy but randomized controlled trials are required to determine the therapeutic range of these drugs and evaluate whether DOAC monitoring can improve outcomes in a clinical setting. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Romain Siriez; Halil Yildiz; Céline Bouvy; Hélène Haguet; Vincent Maloteau; Michaël Hardy; François Mullier; Jean-Michel Dogné; Philippe Hainaut; Jonathan Douxfils Journal: Res Pract Thromb Haemost Date: 2022-04-11
Authors: Tamana Meihandoest; Jan-Dirk Studt; Adriana Mendez; Lorenzo Alberio; Pierre Fontana; Walter A Wuillemin; Adrian Schmidt; Lukas Graf; Bernhard Gerber; Ursula Amstutz; Cedric Bovet; Thomas C Sauter; Lars M Asmis; Michael Nagler Journal: Front Cardiovasc Med Date: 2022-03-17
Authors: Vepusha Sathanantham; Lorenzo Alberio; Cédric Bovet; Pierre Fontana; Bernhard Gerber; Lukas Graf; Adriana Mendez; Thomas C Sauter; Adrian Schmidt; Jan-Dirk Studt; Walter A Wuillemin; Michael Nagler Journal: Life (Basel) Date: 2022-07-11