ADLM Guidance Document on Coagulation Testing in Patients Using Direct Oral Anticoagulants

Abstract Background Coagulation testing has an important role in the diagnosis, monitoring, and therapeutic decision-making for patients with abnormal hemostasis. As the field of anticoagulation options has expanded, the introduction of direct oral anticoagulant (DOAC) drugs has provided an option for patients utilizing drugs that do not require routine monitoring. Patients on these drugs may still need coagulation testing for prognostic purposes, and there are a number of nuances to consider when performing coagulation testing in patients who are prescribed DOACs. Content This document provides guidance on the tests that may or may not be impacted by the presence of DOACs in the blood. A discussion is provided about specific coagulation tests used and the impact of testing samples with a DOAC present. Options are presented to help mitigate the impact of DOACs on the testing. In addition, this document discusses how to test for and interpret DOAC concentrations in specific patient populations.