New recommendations address testing challenges when direct oral anticoagulants interfere with coagulation assays.
The Association for Diagnostics & Laboratory Medicine has released guidance to help navigate coagulation testing in patients taking direct oral anticoagulants (DOACs) that can interfere with test results.
The guidance document addresses testing scenarios that arise when patients on DOACs require coagulation testing for heavy bleeding, suspected clotting disorders, or pre-surgical evaluation. DOACs directly interact with the same clotting factors measured in certain coagulation tests, complicating result interpretation.
“Clinicians ordering coagulation testing for patients taking DOACs should approach these scenarios thoughtfully, as this requires discretion to determine appropriate and optimal timing for testing,” say the document authors Drs Lindsay A.L. Bazydlo, Maximo J. Marin, Anna E. Merrill, Louise M. Man, Olajumoke O. Oladipo, and Neil S. Harris, in a release. “Communication and collaboration with the laboratory leadership and staff is strongly suggested prior to testing.”
Addressing Complex Testing Scenarios
DOACs are among the most commonly prescribed blood thinners, used to prevent stroke, deep vein thrombosis, and pulmonary embolism. Unlike older anticoagulants, DOACs typically do not require routine coagulation monitoring. However, patients may still need coagulation testing in specific clinical situations.
The Academy of Diagnostics & Laboratory Medicine expert panel organized key findings from existing research and medical reports to create practical recommendations for laboratory professionals and clinicians. Major recommendations from the document include the following:
- When possible, labs and healthcare providers should avoid clot-based testing for patients on DOACs. The guidance details the tests that are and are not susceptible to interference from these drugs so that labs and healthcare professionals can make an informed decision on which tests to use for these patients.
- In scenarios where clot-based testing is necessary, labs and clinicians can mitigate DOACs’ potential effects by treating blood samples before testing with agents that neutralize those effects, temporarily discontinuing DOAC treatment before a coagulation test, or temporarily switching a patient to a low-molecular weight heparin.
- In order for any of these strategies to be effective, laboratory medicine professionals and clinicians must communicate effectively, as the perspectives and expertise of both are needed to ensure patients get the appropriate tests and treatments.
The guidance emphasizes the importance of laboratory medical directors providing support to clinical teams on current methodologies and result interpretation for patients on DOACs.
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