Laboratory monitoring of new anticoagulants


  • Donna D. Castellone,

    Corresponding author
    1. Clinical Project Manager Hemostasis/Hematology, Medical, Clinical and Statistical Affairs, Siemens Healthcare Diagnostics, Tarrytown, New York
    • Siemens Healthcare Diagnostics, 511 Benedict Avenue, Tarrytown, NY 10591
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  • Elizabeth M. Van Cott

    1. Director, Coagulation Laboratory, Department of Pathology, Massachusetts General Hospital, Fruit St., Boston, MA 02114
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  • Conflict of interest: D. D. Castellone is employed by Siemens Healthcare Diagnostics, as Clinical Project Manager of Hemostasis/Hematology. The authors are members of NASCOLA (North American Specialized Coagulation Laboratory Association), a nonprofit organization dedicated to the field of specialized coagulation testing, which provides proficiency testing for specialized coagulation laboratories.


Maintaining a balance between bleeding and clotting has always been a challenge in treating coagulation disorders. A perturbation in that balance can be associated with substantial morbidity and mortality. As a result, anticoagulant monitoring is extremely important, and inappropriate testing may lead to complications. There are now a variety of new anticoagulant drugs in clinical use including several direct thrombin inhibitors (DTIs), such as argatroban, bivalirudin, and hirudin, as well as a Factor Xa inhibitor, fondaparinux. There are pitfalls associated with some of the currently used laboratory monitoring tests, and newer alternative laboratory monitoring tests have been investigated (Walenga and Hoppensteadt, Semin Thromb Hemost 2004;30:683–695). In addition, laboratory testing can assist with transitioning patients from DTI to warfarin therapy. Am. J. Hematol. 2010. © 2009 Wiley-Liss, Inc.