Mithoowani Siraj, Siegal Deborah
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Hematology Am Soc Hematol Educ Program. 2024 Dec 6;2024(1):178-185. doi: 10.1182/hematology.2024000666.
Direct oral anticoagulants (DOACs) do not require routine monitoring of anticoagulant effect, but measuring DOAC activity may be desirable in specific circumstances to detect whether clinically significant DOAC levels are present (eg, prior to urgent surgery) or to assess whether drug levels are excessively high or excessively low in at-risk patients (eg, after malabsorptive gastrointestinal surgery). Routine coagulation tests, including the international normalized ratio (INR) or activated partial thromboplastin time (aPTT), cannot accurately quantify drug levels but may provide a qualitative assessment of DOAC activity when considering the estimated time to drug clearance based on timing of last drug ingestion and renal and hepatic function. Drug-specific chromogenic and clot-based assays can quantify drug levels but they are not universally available and do not have established therapeutic ranges. In this review, we discuss our approach to measuring DOAC drug levels, including patient selection, interpretation of coagulation testing, and how measurement may inform clinical decision-making in specific scenarios.
直接口服抗凝剂（DOACs）不需要常规监测抗凝效果，但在特定情况下，检测是否存在具有临床意义的DOAC水平（例如，紧急手术前）或评估高危患者的药物水平是否过高或过低（例如，在吸收不良的胃肠道手术后）时，测量DOAC活性可能是可取的。常规凝血试验，包括国际标准化比值（INR）或活化部分凝血活酶时间（aPTT），不能准确量化药物水平，但在根据最后一次服药时间以及肾功能和肝功能考虑药物清除的估计时间时，可能会提供对DOAC活性的定性评估。特定药物的显色法和基于凝血块的检测方法可以量化药物水平，但并非普遍可用，也没有既定的治疗范围。在本综述中，我们讨论了测量DOAC药物水平的方法，包括患者选择、凝血试验解读，以及测量如何为特定情况下的临床决策提供依据。
