Perspective:

This is a timely review of coagulation laboratory techniques and their effectiveness for monitoring TSOAC agents. The authors conducted a reasonably thorough search for all published studies and nicely summarize their findings in a clinically useful table and figure pairing. While TSOAC agents do not require routine laboratory monitoring, certain clinical scenarios will necessitate the ability to evaluate the degree of anticoagulant effect. The ability to assess for any remaining anticoagulant effect may be particularly beneficial before a high-risk surgical procedure (e.g., cardiac and neurosurgery), when verifying compliance with medication administration, or when managing a patient with life-threatening bleeding. As TSOACs become more commonly prescribed, all clinicians have a responsibility to expand their familiarity with various coagulation laboratory studies beyond the PT/INR and aPTT. Each clinician must familiarize himself/herself with the various coagulation tests performed at his/her laboratory and understand how the various TSOAC agents affect those tests.