Laboratory tests during direct oral anticoagulant treatment? Yes

Excerpt

Warfarin is still the most used oral anticoagulant; in Italy approximately 650,000 subjects were taking warfarin in 2006 with an annual increase of 5 % [1]. The main drawback of warfarin is the high interindividual variability in the dose–response [2]. Variability depends on both environmental factors (e.g., diet and interfering comedications) and endogenous factors (e.g., age, gender, height, weight, comorbidities and genetic). VKORC1, CYP2C9 and CYP4F2 gene polymorphisms are clearly involved in determining the variation in warfarin dose. [3]. Less variability is reported for direct oral anticoagulants although trough plasma concentration varies individually on maintenance treatment [4]. As the increase in drug concentrations is closely related to bleeding events, it is suggested to monitor their effect through specific coagulation tests. The aim would be to find out the best dose for each patient. However, direct oral anticoagulants have shown a fairly predictable effect with no need for routine coagulation monitoring [5]. Moreover, Phase III clinical studies of direct anticoagulants on stroke prevention in atrial fibrillation have clearly shown the efficacy and safety of fixed dose of direct anticoagulants [6]. …