Summary
Introduction. Direct oral anticoagulants (DOACs) are widely used for the management of thromboembolic disorders, particularly in preventing and treating venous thromboembolism and stroke in patients with atrial fibrillation. While routine laboratory monitoring of DOACs is generally not recommended, certain clinical scenarios necessitate their assessment. In Estonia, an increasing demand exists for laboratory-based evaluation of DOAC levels to support clinical decision-making. This study aims to develop a standardized protocol for laboratory assessment of DOAC therapy based on the currently available assays.
Materials and Methods. A comprehensive review of laboratory methods for DOAC assessment in Estonia was conducted, analyzing qualitative and quantitative assays, including anti-Xa activity, thrombin time, and chromogenic assays. The study also evaluated the applicability of the DOAC Dipstick (DOASENSE GmbH, Germany) as a pointof- care test for qualitative urine analysis. International guidelines and expert consensus documents were reviewed to establish a standardized laboratory assessment protocol.
Results. DOAC measurement techniques vary in availability and reliability across Estonian laboratories. Plasma- based methods provide precise quantification but are not universally accessible, while urine-based DOAC Dipstick testing offers a rapid alternative for excluding clinically significant DOAC levels. The study proposes a standard operating protocol, integrating these methodologies to improve DOAC assessment in clinical practice.
Conclusions. Establishing a standardized protocol for DOAC laboratory assessment in Estonia enhances clinical decision-making by providing reliable and accessible testing methods. The integration of plasma and urine-based assays ensures a comprehensive evaluation of DOAC therapy, but further research is required to optimize clinical applicability and patient outcomes.
