Background: Three direct oral anticoagulants (DOACs) are currently registrated for use in Slovenia: dabigatran, rivaroxaban and apixaban. These DOACs are administrated in fixed doses without routine anticoagulant monitoring. However, there are some clinical situations where laboratory measurement may be needed, such as a serious bleeding and thrombotic events, need for urgent surgery, renal or liver insufficiency.

Aims: The classical coagulation tests such as activated partial thromboplastin time (aPTT) or prothrombin time (PT) cannot be used to quantify activity of the drug precisely. In contrast, specific assays (dTT—diluted thrombin time for dabigatran, chromogenic factor Xa assays for the factor Xa inhibitors, correlate well with plasma concentrations. To ensure safe patient treatment in special clinical situations we decided to introduce special assays for DOACs.

Methods: Specific assay for Rivaroxaban was introduced in march 2013, for Dabigatran in february 2015 and Apixaban in may 2016. Assays were performed on BCS XP coagulation analyser and accessibility was 12 hours per day. We analysed number of specific assays from introduction till the end of 2019 and in which clinical settings testing was orded.

Results: The number of assays for Rivaroxaban rise from 13 in 2013 to 267 in 2019; for Dabigatran from 36 in 2015 to 197 in 2019; for Apixaban from 19 in 2016 to 187 in 2019. Approximately 60% of assays were orded for urgent trauma, neurological, orthopedic, abdominal surgery and medical ill patients.

Conclusions: Our analyses shows the growing demand for specific assays, esspecialy in urgent clinical settings. From april 2018 assays are available 24 hours per day and safer treatment of patients is guaranteed.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/monitorig-of-direct-oral-anticoagulants-in-routine-practice/