Fast Five Quiz: Direct Oral Anticoagulant Therapy for Atrial Fibrillation

Sandeep K. Goyal, MD


April 02, 2020

Based on the rapid onset, short half-life, and predictable pharmacologic profile of DOAC agents, patients with AF receiving DOAC therapy do not require frequent laboratory monitoring. For patients taking DOAC agents, the EHRA guidelines recommend routine monitoring and clinical assessment, including serum creatinine level, liver function testing, and complete blood cell count, every 6 months. However, no recommendation is made regarding the monitoring of coagulations assays. Patients receiving DOAC therapy do not require regular monitoring of coagulation assays, but when desired, drug plasma levels may be assessed by checking anti-FXa assays for patients taking apixaban, edoxaban, or rivaroxaban, and activated partial thromboplastin time or thrombin time for patients taking the direct thrombin inhibitor (DTI) dabigatran.

Only patients taking VKAs must adhere to dietary restrictions that limit vitamin K intake. Patients receiving DOAC therapy do not have any dietary restrictions. Therefore, they do not require laboratory monitoring for dietary intake of foods high in vitamin K or consumption of other products that inhibit platelet aggregation as they will not augment the anticoagulatory effects of DOAC therapy.

Although DOAC agents can lengthen PT and INR, patients receiving these anticoagulants do not require routine monitoring.

Learn more about clinical assessment and laboratory monitoring of patients receiving DOAC therapy.


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