Hemostasis and bleeding disorders Podcast

Monitoring Anticoagulation: Yes or No?

A clinical discussion on anticoagulation monitoring

Prof. Dimitrios Tsakiris

Prof. Michael Nagler

Publication Date

Aug 2023

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Listen to expert haematologists discuss anticoagulation monitoring in this educational podcast episode. You'll hear Prof. Tsakiris and Assoc. Prof. Nagler talk about:

Direct oral anticoagulants (DOAC) monitoring scenarios

When DOAC monitoring is necessary for acute situations like bleeding, surgery and thrombolysis, while recognising its limitations

Selective anticoagulation monitoring

Differentiating routine monitoring from critical drug level assessments and the impact on clinical decisions and patient care

Anti-Xa advantages

The benefits of Anti-Xa assays for anticoagulation monitoring, including potential standardisation and shifting from traditional assays for unfractionated heparin

This podcast is the first episode in a series on thrombosis in a different clinical situations. The second episode, on cancer-associated thrombosis, is available here. Episodes three and four will focus on venous thromboembolism and peri-operative thrombo-prophylaxis. Check the COR2ED website for future episodes over the next few months.

Clinical Takeaways

DOAC monitoring is useful in special situations, but need not be done on a routine basis
DOAC choice and dosing should be guided by individual clinical characteristics rather than the monitoring results
Anti-Xa assays have key advantages in the determination of DOAC drug levels and in the monitoring of unfractionated heparin
Patients with vitamin K antagonists should be monitored in designated treatment programmes such as patient self-management

Prof. Dimitrios A. Tsakiris, MD was born in Thessaloniki, Greece and obtained his Diploma of Medicine (1982) at the Medical School, Aristotle University of Thessaloniki, Greece. He started his training in Clinical Haematology at the AHEPA University Hospital in Thessaloniki and completed it at the University Hospital Basel in Basel, Switzerland, where he has been working since 1987. He holds a license for Clinical Haematology and Laboratory Haematology. He spent one year (1996) as a Research Associate in Platelet Research at the Mount Sinai School of Medicine, New York, NY, USA. He has held a professorship in Haematology at the Faculty of Medicine, University of Basel, Switzerland since 2004 and serves also as a visiting Professor of Hematology at the Medical School of the Aristotle University of Thessaloniki. He has served as Head of Haemostasis since 2009 and Head of Diagnostic Haematology and Haemostasis (2014-2021), as well as member of the Stem Cell Transplant and Cell-Therapy Center Basel at the University Hospital Basel, Switzerland. Since 2021 he has been Director of Thrombosis and Haemostasis and Co-Head Hematology at SYNLAB Suisse SA, Switzerland. His main fields of scientific interests are platelet activation, platelet disorders, diagnosis and treatment of bleeding disorders and thrombophilia, disorders of haemostasis and endothelial cells after stem cell transplants. He has presented over 140 peer-reviewed original articles and reviews.

Prof. Dimitrios Tsakiris has received financial support/sponsorship for research support, consultation, or speaker fees from the following companies:

Consultant/Advisory board: Pfizer, Novartis, Genentech, Merck, Radius Health, Immunomedics/Gilead, Sanofi, Daiichi Pharma/Astra Zeneca, Eli Lilly, Mersana. Contracted Research/Grant (to institution): Genentech, Novartis, Pfizer, Merck, Sanofi, Radius Health, Immunomedics/Gilead, Daiichi Pharma/Astra Zeneca, Eli Lilly.

As a laboratory specialist, haematologist, and epidemiologist, Michael Nagler has a wide range of training and expertise. Currently, he is the deputy director of the Centre for Laboratory Medicine at Inselspital University Hospital in Switzerland and an associate professor at the University of Bern. The focus of his research is one of the most common clinical questions: “What does this laboratory test result mean for the individual patient?” To strive in this, he advances diagnostic research methodologies, validates and implements new testing strategies, and develops creative decision support tools, specifically diagnostic machine learning algorithms.