Page 2177 - Hematology_ Basic Principles and Practice ( PDFDrive )

1930 Part XII Hemostasis and Thrombosis

clinicians should consider how it will affect management, and if it is elevation occurs in pregnancy, large vessel thrombosis, hepatic failure,
aligned with the patient’s values and preferences. and many other conditions. Isolated D-dimer elevation in the absence
of another etiology can also suggest chronic DIC. Laboratory testing
can be repeated serially to monitor the severity of DIC, and its
Monitoring Anticoagulant Therapy response to treatment.

The coagulation laboratory plays an important role in the monitoring
of patients on anticoagulant therapy. Historically, monitoring was ACKNOWLEDGMENTS
limited to unfractionated heparin and warfarin, which are monitored
using the clot-based APTT and INR assays, respectively. However, The author wishes to recognize the invaluable assistance and expertise
coagulation laboratories are increasingly developing assays to monitor of Karen A. Moffat, who provided many thoughtful comments on
low-molecular-weight heparin (LMWH), fondaparinux, parenteral versions of this chapter.
direct thrombin inhibitors, and the target-specific oral anticoagulants
(TSOACs), which include dabigatran, rivaroxaban, and apixaban.
Therapeutic ranges for these agents are not clinically validated, and REFERENCES
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