Direct oral anticoagulant care: focus on management and monitoring

Patients at risk or diagnosed with arterial or venous thrombosis may require anticoagulant therapy to prevent the onset, progression or recurrence of a thrombotic event. This thesis investigated the organisation of anticoagulant care in the Netherlands. Further, the stability of direct oral anticoagulation (DOAC) activity levels over time in relation to patient characteristics, dosing and adherence to medication was assessed. The second part of this thesis reviews several coagulation tests for DOAC. DOAC testing may be useful in the setting of critical clinical situations such as lifethreatening bleeding or need for emergent surgery, especially with the availability of DOAC reversal agents. The development of global assays for detecting levels of a DOAC has been delayed by the persistent idea that DOAC testing would no longer be needed as DOAC dosing is not dependent on such testing. While the data in this thesis also support the notion that repeated testing is unnecessary in many subjects, or at least not more often than (perhaps) annually in patients at risk.