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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).