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BioMed Research International
Volume 2015 (2015), Article ID 345138, 13 pages
http://dx.doi.org/10.1155/2015/345138
Review Article

Non-VKA Oral Anticoagulants: Accurate Measurement of Plasma Drug Concentrations

1Department of Pharmacy, University of Namur, Namur Thrombosis and Haemostasis Center (NTHC), Namur Research Institute of Life Sciences (NARILIS), 5000 Namur, Belgium
2Department of Haemostasis, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
3Department of Haematology, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Haemostasis Center (NTHC), Namur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium
4Haematology Laboratory, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Haemostasis Center (NTHC), Namur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium

Received 30 May 2014; Accepted 10 November 2014

Academic Editor: Jack Ansell

Copyright © 2015 Jonathan Douxfils et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Non-VKA oral anticoagulants (NOACs) have now widely reached the lucrative market of anticoagulation. While the marketing authorization holders claimed that no routine monitoring is required and that these compounds can be given at fixed doses, several evidences arisen from the literature tend to demonstrate the opposite. New data suggests that an assessment of the response at the individual level could improve the benefit-risk ratio of at least dabigatran. Information regarding the association of rivaroxaban and apixaban exposure and the bleeding risk is available in the drug approval package on the FDA website. These reviews suggest that accumulation of these compounds increases the risk of experiencing a bleeding complication. Therefore, in certain patient populations such as patients with acute or chronic renal impairment or with multiple drug interactions, measurement of drug exposure may be useful to ensure an optimal treatment response. More specific circumstances such as patients experiencing a haemorrhagic or thromboembolic event during the treatment duration, patients who require urgent surgery or an invasive procedure, or patient with a suspected overdose could benefit from such a measurement. This paper aims at providing guidance on how to best estimate the intensity of anticoagulation using laboratory assays in daily practice.