Monitoring of Anticoagulant Therapy in Heart Disease: Considerations for the Current Assays: A systematic Review

Anticoagulant therapy is a cornerstone in the management of cardiovascular diseases, including atrial fibrillation, venous thromboembolism, and mechanical heart valve replacement. While these therapies significantly reduce thromboembolic events, they are associated with an inherent risk of bleeding, making precise monitoring essential for optimizing clinical outcomes. This systematic review evaluates the current laboratory assays used to monitor anticoagulant therapy, their clinical relevance, limitations, and emerging methodologies. Traditional monitoring methods, including prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR), remain widely utilized. PT and INR are standard for warfarin therapy; however, variations in thromboplastin reagents and laboratory practices contribute to inter-laboratory variability, potentially affecting dosing accuracy. aPTT is commonly employed for unfractionated heparin monitoring, yet its sensitivity is influenced by reagents and instrumentation, prompting recommendations for institution-specific therapeutic ranges and anti-Xa assay utilization for more precise assessment. Direct oral anticoagulants (DOACs), such as dabigatran, rivaroxaban, apixaban, and edoxaban, offer predictable pharmacokinetics and reduce the need for routine monitoring. Nonetheless, clinical situations including renal or hepatic impairment, bleeding complications, and urgent surgical interventions may necessitate evaluation of anticoagulant effects. Emerging assays, including anti-Xa activity measurement, thrombin generation assays, and point-of-care testing, demonstrate improved accuracy and patient-centered monitoring potential, though limited accessibility and standardization remain challenges. Overall, integrating these advanced methods with conventional assays can enhance anticoagulation management, minimize adverse events, and improve patient safety. Standardization of laboratory protocols, adherence to guidelines, and ongoing research are critical to achieving reliable monitoring across diverse clinical settings.

کلیدواژه ها:

Anticoagulant Therapy ، heart disease ، laboratory assays ، INR ، aPTT ، DOACs