Direct Oral Anticoagulants: Laboratory Challenges and Antidotes

Research output: Contribution to journalResearch articleContributedpeer-review


  • Jan Beyer-Westendorf - , Department of internal Medicine I, University Hospital Carl Gustav Carus Dresden (Author)
  • Christina Köhler - , Department of Medicine I Thrombosis Research (Author)


The use of direct oral anticoagulants (DOACs) is increasing in patients needing treatment of venous thromboembolism (VTE) and stroke prevention in atrial fibrillation (SPAF). This is due to the net clinical benefit in comparison to vitamin K antagonists (VKAs). The rise in DOAC use is accompanied by a remarkable reduction in heparin and VKA prescriptions. However, this rapid change in anticoagulation patterns brought new challenges to patients, prescribers, laboratories, and emergency physicians. Patients have new liberties concerning nutritional habits and comedication and no longer need frequent monitoring or dose adjustments. Still, they have to comprehend that DOACs are potent anticoagulants that may cause or contribute to bleeding. Challenges for the prescriber include decision pathways for choosing the right anticoagulant and dosage for a specific patient and to change bridging practice in case of invasive procedures. Laboratory personnel are challenged by DOAC due to limited 24/7 availability of specific DOAC quantification tests and by the impact of DOAC on routine coagulation assays and thrombophilia tests. Challenges for the emergency physician result from the increasing age of DOAC anticoagulated patients, the difficulties to establish last intake of DOAC type and dosage, to interpret coagulation test results in emergency situations, and to make decisions for or against DOAC reversal strategies in acute bleeding or urgent surgery. In conclusion, although DOACs make long-term anticoagulation safer and more convenient for patients, DOACs pose challenge to all healthcare providers involved in anticoagulation decisions. The key to correct patient management and optimal outcome therefore lies in education.


Original languageEnglish
Pages (from-to)37-43
Number of pages7
Issue number1
Publication statusPublished - Feb 2023

External IDs

Scopus 85148678952



  • Humans, Antidotes/therapeutic use, Laboratories, Anticoagulants/therapeutic use, Heparin/therapeutic use, Venous Thromboembolism/drug therapy, Hemorrhage/chemically induced, Atrial Fibrillation/drug therapy, Administration, Oral, Vitamin K

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