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Novel oral anticoagulants (NOACs) are designed to avoid the need for monitoring of drug levels in routine clinical use. This has not impeded the development of laboratory tests for monitoring drug levels, but their place in routine clinical use of NOACs is currently contentious. Laboratory kits are now commercially available for measuring anti-Xa activity in patients given rivaroxaban (Bayer Healthcare AG, Leverkusen, Germany), an anti-Xa inhibitor. Besides such specific assays, rivaroxaban also affects routine coagulation tests such as the prothrombin time (PT). This effect is however dependent on the type of thromboplastin used.1 We describe our experience recently where access to anti-Xa monitoring and the differential sensitivity of two prothrombin assays were used to manage a difficult situation.
A middle-aged woman with end-stage renal failure presented with deep vein thrombosis of the right lower limb. This occurred as a complication of heparin-induced thrombocytopenia (HIT) which developed 9 days after exposure to heparin used in haemodialysis and maintenance of patency of an internal jugular venous access catheter. HIT was suspected because of a precipitous drop in her platelet count from 177×109/L 3 days earlier to 61×109/L, together with the new onset of thrombosis. This was supported by a positive test result from the Asserachrom HPIA polyspecific antibody assay …