PDF(Pubmed)
Abstract：
Direct oral anticoagulants (DOACs) exert anticoagulation effect by directly inhibiting Factor Xa (rivaroxaban, apixaban, and edoxaban) or thrombin (dabigatran). Though DOACs are characterized by fixed-dose prescribing and generally do not require routine laboratory drug-level monitoring (DLM), circumstances may arise where the DLM may aid in clinical decision-making, including DOAC dose adjustment, anticoagulant class change, or decisions to withhold or administer reversal agents. We review the current literature that describes high-risk patient groups in which DLM may be beneficial for improved patient anticoagulation management and stewardship. The review also summarizes the limitations of conventional coagulation testing and discuss the emerging utility of quantitative methods for routine and rapid emergent evaluation of DOAC drug levels-in particular, the Anti-Xa activity to detect Factor Xa Inhibitors (rivaroxaban, apixaban, and edoxaban). Both technical and regulatory barriers to widespread DLM implementation are limiting factors to further clinical research that must be overcome, in order to propose universal DOAC DLM strategies and provide clinical-laboratory correlation to formally classify high-risk patient groups.
摘要：
直接口服抗凝剂（DOACs）通过直接抑制因子Xa（利伐沙班，阿哌沙班,和edoxaban）或凝血酶（达比加群）。尽管DOAC的特点是固定剂量处方，通常不需要常规实验室药物水平监测(DLM)，可能出现DLM可能有助于临床决策的情况，包括DOAC剂量调整，抗凝剂类改变,或决定扣留或管理逆转代理人。我们回顾了目前描述高风险患者群体的文献，其中DLM可能有利于改善患者抗凝管理和管理。该综述还总结了常规凝血测试的局限性，并讨论了定量方法对DOAC药物水平的常规和快速紧急评估的新兴效用-特别是，检测因子Xa抑制剂的抗Xa活性(利伐沙班，阿哌沙班,和edoxaban）。广泛实施DLM的技术和监管障碍都是必须克服的进一步临床研究的限制因素。为了提出通用的DOACDLM策略，并提供临床-实验室相关性以正式对高危患者组进行分类。
