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Ifeanyichukwu Ifechidere: DOAC Monitoring – What To Order, When, And Why
Ifeanyichukwu Ifechidere/LinkedIn
Jul 1, 2026, 12:11

Ifeanyichukwu Ifechidere: DOAC Monitoring – What To Order, When, And Why

Ifeanyichukwu Ifechidere, Specialist Biomedical Scientist at Sheffield Teaching Hospitals NHS Foundation Trust, shared a post on LinkedIn:

“Not every patient on a DOAC needs monitoring.

But when they do, ordering the wrong assay can lead to the wrong clinical decision.

This is where many clinicians-and even laboratories-get caught out.

The question isn’t just ‘Should I measure the DOAC?’

It’s ‘Which assay answers my clinical question?’

Here’s a simple way to think about it:

  • Anti-Xa assay
  • Best for rivaroxaban, apixaban, and edoxaban
  • Use a drug-specific calibrated Anti-Xa assay
  • Helpful in major bleeding, urgent surgery, suspected overdose, renal impairment, or unexpected thrombosis.

Dilute Thrombin Time (dTT)

  • Best for dabigatran
  • Provides a quantitative estimate of dabigatran concentration.
  • More reliable than routine clotting tests.

DOAC Screen

  • Useful as a rapid screening tool to determine whether a clinically significant DOAC is present.
  • Helpful in emergency settings when the anticoagulant history is uncertain.
  • It is not a substitute for drug-specific quantification.

And here’s the part that’s often overlooked…

Timing matters just as much as assay selection.

A result is difficult to interpret unless you know:

  • Which DOAC the patient is taking
  • The dose
  • The time of the last dose
  • Renal function
  • Whether you’re measuring a peak or trough level

Without that context, even the ‘right’ test can produce a misleading interpretation.

The takeaway:

The goal of DOAC testing isn’t simply to detect the drug.

It’s to answer a specific clinical question with the right assay at the right time.

What is the biggest challenge your laboratory or clinical team faces when interpreting DOAC assays?”

Ifeanyichukwu Ifechidere: DOAC Monitoring - What To Order, When, And Why

Find more posts featuring Ifeanyichukwu Ifechidere on Hemostasis Today.

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