The potential use of laboratory monitoring during individualizing the dosage of direct oral anticoagulants - a literature review
Abstract
Introduction and Aim: Direct oral anticoagulants (DOACs) are administered in fixed daily doses without the need for routine monitoring. Despite significant inter-patient variability in systemic exposure, data regarding populations predisposed to abnormal concentrations are limited.
The objective of this literature review was to analyse selected factors that may significantly influence DOAC concentrations within clinical settings, emphasising situations in which laboratory monitoring of DOACs might be applicable. Methods: Publications from Pubmed and Scopus databases assessing the effect of advanced age, altered renal function, sarcopenia, obesity, medication adherence, and drug interactions on DOAC concentrations, as determined by anti-Xa activity or diluted thrombin time were included.
Results: In total, 34 studies fulfilled the inclusion criteria. Among the assessed factors, increasing age, renal function, decreasing weight, frailty, medication adherence, and drug interactions demonstrated a statistically significant impact on therapeutic DOAC concentrations.
Conversely, the influence of obesity was inconclusive. Conclusion: Therapeutic monitoring of DOAC concentrations in patients with the above-mentioned factors could optimize treatment outcomes.