In a nutshell: Testing DOAC levels-when, why and what it means?

Plasma direct oral anticoagulant (DOAC) levels are not routinely required for the majority of patients; however, they may provide valuable information in urgent clinical situations, including perioperative management, life- or limb-threatening bleeding and patients requiring thrombolysis, when measurement mostly aims to determine whether a clinically significant concentration of DOAC is present in plasma. In non-urgent indications, including investigation of DOAC failure and in patients with extremes of body weight or drug-drug interactions, levels may assist clinical decision-making by determining whether the plasma DOAC level is within expected therapeutic ranges. 'In a nut-shell' review, we summarise the current recommendations and limitations regarding testing DOAC levels.