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Table 3 Applicability of laboratory assays in the management of oral anticoagulation

From: Global assays and the management of oral anticoagulation

 

Monitoring VKA treatment

Monitoring NOAC treatment

 

Anti-coagulation

Reversal

Anti-coagulation

Reversal

Global assays

    

APTT

P1

P1

P1

N2

PT/INR

A

A

P1

P3,4

TEG/ROTEM

Q3

Q3

P1

P3

TGA

A3

A3

P1

P3,4

Specialty assays

    

ECT/TT

N2

N2

A

N2

Xa-i/DTI

N2

N2

A

N2

  1. A, applicable.
  2. P, partly applicable; use with caution.
  3. Q, questionable.
  4. N, not applicable.
  5. 1moderate to low sensitivity.
  6. 2no sensitivity.
  7. 3requires further validation and standardization.
  8. 4assay normalization depends on NOAC type, NOAC concentration, TF concentration and used thromboplastin reagent.
  9. This table summary clearly shows that the applicability of a particular test in monitoring NOAC or VKA anticoagulation does not translate directly to applicability in reversal assessment. The PT remains the appropriate test when managing VKA anticoagulation. TGA may also be suitable, but this requires further validation. Specialty assays suited for NOAC monitoring (ecarin clotting time, ECT; thrombin time, TT; direct thrombin inhibitor assay, DTI; chromogenic factor Xa inhibitor assay, Xa-i) do not apply to reversal assessment. Monitoring NOAC reversal is feasible with PT, TEG/ROTEM and TGA. However, most readout parameters only show partial NOAC reversal. Global assays, in general, show low sensitivity to NOACs (see Table 2).