Beyond Routine Monitoring: A Comprehensive Review of Direct Oral Anticoagulants and the Role of Coagulation Profiles in Their Management.

Direct oral anticoagulants (DOACs) have revolutionized anticoagulation therapy, providing effective and safe management of thrombosis and related conditions. As their use continues to grow, accurately monitoring their effects is essential to achieve optimal patient outcomes. Traditional coagulation tests, such as prothrombin time (PT) and activated partial thromboplastin time, have long been used to evaluate clotting function and bleeding risk in patients on anticoagulants. However, these standard tests often fall short with DOACs due to complex interactions between the drugs and the assays. While PT offers some insight into coagulation, its reliability for drugs like apixaban, one of the most commonly prescribed DOACs, remains debated. This limitation underscores the need for alternative monitoring strategies, such as the modified diluted PT, which shows promise in providing more accurate assessments of DOAC levels. This review discusses the pharmacokinetics of DOACs, their impact on standard coagulation tests, and various factors - such as liver disease and drug interactions - that complicate these assessments. Additionally, it highlights the importance of incorporating specific assays, including anti-factor Xa activity and dilute thrombin time, for precise anticoagulation management. By synthesizing current evidence, this review aims to identify improved methods for monitoring DOAC therapy, guide clinicians in optimizing anticoagulation treatment, and ultimately enhance patient outcomes.