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

Thromb Haemost. 2021 Aug;121(8):1008-1020. doi: 10.1055/a-1450-8178. Epub 2021 May 30.


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.

Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Anticoagulation Reversal / standards
  • Blood Coagulation / drug effects*
  • Blood Coagulation Tests / standards*
  • Consensus
  • Drug Monitoring / standards*
  • Evidence-Based Medicine
  • Factor Xa Inhibitors / adverse effects
  • Factor Xa Inhibitors / blood
  • Factor Xa Inhibitors / therapeutic use*
  • Hemorrhage / chemically induced
  • Hemorrhage / prevention & control
  • Humans
  • Point-of-Care Testing / standards*
  • Predictive Value of Tests
  • Reproducibility of Results


  • Factor Xa Inhibitors