Published online Dec 26, 2015. doi: 10.5662/wjm.v5.i4.212
Peer-review started: July 5, 2015
First decision: July 28, 2015
Revised: September 22, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: December 26, 2015
Thromboembolic disease is a major leading cause of mortality and morbidity in industrialized countries. Currently, the management of these patients is challenging due to the availability of new drugs with proven efficacy and security compared to traditional oral vitamin K antagonists. These compounds are characterized by a predictable pharmacokinetic profile for which blood monitoring is not routinely needed. Nevertheless, some data have suggested inter-patient variability in the anticoagulant effect of these drugs, raising concerns about their effectiveness and safety. Although mass-spectrometry is the gold standard to determine drug plasma concentrations, this method is not widely available in every-day practice and some coagulation assays are commonly used to determine the anticoagulant effect of these drugs. The present review aims to summarize the current knowledge regarding the clinical question of how and when to monitor patients with new anticoagulant oral agents.
Core tip: New oral anticoagulants are replacing oral vitamin K antagonists for some practical advantages, like unnecessary monitoring and a better pharmacokinetic profile. Nevertheless, in some circumstances, their anticoagulant activity must be monitored in order to prevent adverse outcomes. In this minireview a list of the available laboratory test are reviewed to better understand the pros and cons of each analysis.