Anticoagulants form one arm of antithrombotic therapy, the other being antiplatelet agents. The common mechanism of action of these medications is preventing fibrin formation by inhibiting one or more steps along the coagulation cascade. Although warfarin and heparin were the mainstay oral and parenteral anticoagulants of the 20th century, today’s perioperative clinicians are faced with other unique classes of agents. Specifically, direct oral anticoagulants are now available to inhibit factor Xa or thrombin. This presents a challenge in monitoring since the effects of these newer agents on standard testing do not always reflect the degree of anticoagulation being achieved within the patient.

This focused review will detail the most common coagulation tests used to assess the level of patient anticoagulation. These will be organized into tests obtained from the central laboratory which are often ordered pre- or...

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