Managing Direct Oral Anticoagulant Inhibitor to Heparin Conversion; Heparin Anti-Xa assay or aPTT?

Ever since the introduction of the direct oral anticoagulants (DOACs), such as apixaban and rivaroxaban, laboratory staff and clinicians have been confronted with unique challenges in determining optimal practices when transitions to heparin infusions are needed for patients at high risk of thrombosis. Heparin infusions are commonly needed for patient on DOACs who are admitted to the acute care setting, yet little guidance has been provided on how to manage these transitions. Due to these challenges, clinicians and their laboratory partners have been developing optimal processes to manage these transitions. Recently, a comprehensive practice guideline was published on how to manage these transitions along with an assessment of its performance versus an alternative strategy. This will be discussed in detail, and examples will be provided in using that guideline to manage care.