Direct oral anticoagulants (DOACs): From the laboratory point of view
Direct oral anticoagulants (DOACs) represent a new generation of drugs that have been increasingly used in the prevention and treatment of thromboembolic states. According to the mechanism of anticoagulant action, DOACs are divided into two groups: direct inhibitors of thrombin (dabigatran) and dire...
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Sciendo
2022-12-01
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| Series: | Acta Pharmaceutica |
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| Online Access: | https://doi.org/10.2478/acph-2022-0034 |
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| author | Margetić Sandra Goreta Sandra Šupraha Ćelap Ivana Razum Marija |
| author_facet | Margetić Sandra Goreta Sandra Šupraha Ćelap Ivana Razum Marija |
| author_sort | Margetić Sandra |
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| description | Direct oral anticoagulants (DOACs) represent a new generation of drugs that have been increasingly used in the prevention and treatment of thromboembolic states. According to the mechanism of anticoagulant action, DOACs are divided into two groups: direct inhibitors of thrombin (dabigatran) and direct inhibitors of activated factor X (FXa) (rivaroxaban, apixaban, edoxaban, betrixaban). Compared to the vitamin K antagonists, DOACs are superior in terms of onset of action, pharmacokinetic and pharmacodynamics properties and fixed daily dose without the need for routine coagulation monitoring. Despite these advantages, there are clinical conditions in which laboratory measurement of DOACs should be performed. Although DOACs have an impact on screening haemostasis assays (prothrombin time, PT; activated partial thromboplastin time, aPTT; and thrombin time, TT), these tests are not appropriate for quantifying drug levels. Therefore, specific quantitative methods (LC-MS/MS as a gold standard method for all DOACs, coagulometric and chromogenic assays for dabigatran, and chromogenic anti-Xa assays with drug-specific calibrators for inhibitors of FXa) should only be used for determination of DOACs concentration. The aim of this review is to present all aspects of laboratory assessment of DOACs, including pre-analytical, analytical and post-analytical factors in the overall testing process with a special accent on the available specific quantitative methods for measurement of DOACs in circulation. |
| format | Article |
| id | doaj-art-2bc9acf0b0e146d5b6b0386fa8b957f2 |
| institution | Kabale University |
| issn | 1846-9558 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | Sciendo |
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| spelling | doaj-art-2bc9acf0b0e146d5b6b0386fa8b957f22025-02-03T06:37:55ZengSciendoActa Pharmaceutica1846-95582022-12-0172445948210.2478/acph-2022-0034Direct oral anticoagulants (DOACs): From the laboratory point of viewMargetić Sandra0Goreta Sandra Šupraha1Ćelap Ivana2Razum Marija3Department of Clinical Chemistry Sestre milosrdniceUniversity Hospital Center, Zagreb, CroatiaDepartment of Biochemistry and Molecular Biology, University of Zagreb Faculty of Pharmacy and BiochemistryCroatiaDepartment of Clinical Chemistry Sestre milosrdniceUniversity Hospital Center, Zagreb, CroatiaDepartment of Clinical Chemistry Sestre milosrdniceUniversity Hospital Center, Zagreb, CroatiaDirect oral anticoagulants (DOACs) represent a new generation of drugs that have been increasingly used in the prevention and treatment of thromboembolic states. According to the mechanism of anticoagulant action, DOACs are divided into two groups: direct inhibitors of thrombin (dabigatran) and direct inhibitors of activated factor X (FXa) (rivaroxaban, apixaban, edoxaban, betrixaban). Compared to the vitamin K antagonists, DOACs are superior in terms of onset of action, pharmacokinetic and pharmacodynamics properties and fixed daily dose without the need for routine coagulation monitoring. Despite these advantages, there are clinical conditions in which laboratory measurement of DOACs should be performed. Although DOACs have an impact on screening haemostasis assays (prothrombin time, PT; activated partial thromboplastin time, aPTT; and thrombin time, TT), these tests are not appropriate for quantifying drug levels. Therefore, specific quantitative methods (LC-MS/MS as a gold standard method for all DOACs, coagulometric and chromogenic assays for dabigatran, and chromogenic anti-Xa assays with drug-specific calibrators for inhibitors of FXa) should only be used for determination of DOACs concentration. The aim of this review is to present all aspects of laboratory assessment of DOACs, including pre-analytical, analytical and post-analytical factors in the overall testing process with a special accent on the available specific quantitative methods for measurement of DOACs in circulation.https://doi.org/10.2478/acph-2022-0034direct oral anticoagulants ( doacs)anticoagulationlaboratory monitoring |
| spellingShingle | Margetić Sandra Goreta Sandra Šupraha Ćelap Ivana Razum Marija Direct oral anticoagulants (DOACs): From the laboratory point of view Acta Pharmaceutica direct oral anticoagulants ( doacs) anticoagulation laboratory monitoring |
| title | Direct oral anticoagulants (DOACs): From the laboratory point of view |
| title_full | Direct oral anticoagulants (DOACs): From the laboratory point of view |
| title_fullStr | Direct oral anticoagulants (DOACs): From the laboratory point of view |
| title_full_unstemmed | Direct oral anticoagulants (DOACs): From the laboratory point of view |
| title_short | Direct oral anticoagulants (DOACs): From the laboratory point of view |
| title_sort | direct oral anticoagulants doacs from the laboratory point of view |
| topic | direct oral anticoagulants ( doacs) anticoagulation laboratory monitoring |
| url | https://doi.org/10.2478/acph-2022-0034 |
| work_keys_str_mv | AT margeticsandra directoralanticoagulantsdoacsfromthelaboratorypointofview AT goretasandrasupraha directoralanticoagulantsdoacsfromthelaboratorypointofview AT celapivana directoralanticoagulantsdoacsfromthelaboratorypointofview AT razummarija directoralanticoagulantsdoacsfromthelaboratorypointofview |