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2021 Update of the International Council for Standardization in Haematology Recommendations for Laboratory Measurement of Direct Oral Anticoagulants

Authors & Contributors

Jonathan Douxfils - Dorothy M. Adcock - Shannon M. Bates - Emmanuel J. Favaloro - Isabelle Gouin-Thibault - Cecilia Guillermo - Yohko Kawai - Edelgard Lindhoff-Last - Steve Kitchen - Robert C. Gosselin 

First Published

19 March 2021





In 2018, the International Council for Standardization in Haematology (ICSH) published a consensus document providing guidance for laboratories on measuring direct oral anticoagulants (DOACs).


Since that publication, several significant changes related to DOACs have occurred, including the approval of a new DOAC by the Food and Drug Administration, betrixaban, and a specific DOAC reversal agent intended for use when the reversal of anticoagulation with apixaban or rivaroxaban is needed due to life-threatening or uncontrolled bleeding, andexanet alfa. In addition, this ICSH Working Party recognized areas where additional information was warranted, including patient population considerations and updates in point-of-care testing.

The information in this manuscript supplements our previous ICSH DOAC laboratory guidance document.


The recommendations provided are based on (1) information from peer-reviewed publications about laboratory measurement of DOACs, (2) contributing author's personal experience/expert opinion and (3) good laboratory practice.

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