Abstract
Direct oral anticoagulants (DOACs) have emerged as an alternative to vitamin K antagonists for many indications, including atrial fibrillation and venous thromboembolism. The anticoagulant effect of DOACs is usually directly proportional to its plasma concentration. Routine monitoring of DOACs in the laboratory is, therefore, not recommended. However, there are some clinical situations in which measuring the anticoagulant effect of DOACs is desirable, such as acute renal impairment, thrombosis despite a correct DOAC intake or immediate DOAC reversion requirement. Liquid chromatography/coupled tandem mass spectrometry is the most accurate assay to evaluate DOAC plasma concentration. This procedure is not available in the majority of clinical laboratories, though. Here, the main feasible analysis in the urgent and routine clinical laboratory, in addition to the assay of choice depending on the DOAC, is described. This review also focuses on how to optimally reverse DOAC activity and describes strategies to minimize interferences in DOAC monitoring.