Laboratory Monitoring of DOACs? Merits&Pitfalls (Review Article with Latest Updates)

Background DOACs are considered to be more effective and safer than warfarin, and offers several advantages such as predictable pharmacokinetics, allowing for standardized dosing without monitoring, a lack of food interactions and fewer drug interactions. This studys objective was to systematically review and summarize current evidence regarding laboratory measurement of the anticoagulant activity of dabigatran, rivaroxaban, and apixaban. Discussion-For Dibigatran, normal TT excludes clinically relevant drug levels and normal APTT excludes excess drug levels. The best monitoring tests for Dabigatran at therapeutic plasma concentration is Dilute TT, ECA& ACT. Rivaroxaban& Apixaban at therapeutic drug concentration can be best monitored by Anti-Xa assay& normal level excludes clinically relevant drug. Summary- Dabigatran, rivaroxaban, and apixaban exhibit variable effects on coagulation assays& same drug level affects differently in different persons. Studying pharmacokinetics, bioavailability half life and time dependent trough& peak plasma concentration of drugs aids in monitoring& interpretation of test results. Still research studies are required to gather thorough information on the relationship between drug levels and clinical outcomes