#USA #Washington #ADLM #coagulants #blood thinners

Introduction

On November 4, 2025, the Association for Diagnostics & Laboratory Medicine (ADLM), previously known as AACC, announced significant new guidelines aimed at optimizing coagulation testing for patients using blood thinners, particularly direct oral anticoagulants (DOACs). This initiative seeks to address the complexities clinicians face in accurately diagnosing and providing care for these patients, ensuring they receive the best possible treatment without unnecessary complications.

Understanding DOACs and Their Challenges

Direct oral anticoagulants are modern blood thinners utilized to prevent life-threatening conditions such as strokes, deep vein thrombosis, and pulmonary embolisms. Unlike traditional anticoagulants, they do not require frequent monitoring through coagulation testing, which assesses the blood's clotting ability. However, there are circumstances where patients on DOACs might still require coagulation assessments, such as when they experience severe bleeding, are being evaluated for clotting disorders, or need tests before surgery to manage bleeding risks effectively.

The challenge arises from the fact that DOACs interfere with specific clotting factors measured during these tests, complicating accurate assessments. Recognizing this, ADLM experts developed a comprehensive guidance document synthesizing existing research and clinical practices to benefit healthcare providers.

Key Recommendations from the ADLM Guidelines

The new guidelines offer practical recommendations for both healthcare providers and laboratory professionals. Here are some of the major points outlined:
1. Avoiding Clot-Based Testing:
Ideally, labs and clinicians should steer clear of clot-based tests for patients taking DOACs, unless absolutely necessary. The guidelines specify which coagulation tests are susceptible to interference from these medications and suggest alternative testing methods.
2. Mitigating DOAC Effects in Testing:
In scenarios where such tests are unavoidable, labs may employ strategies to counteract the effects of DOACs. These strategies include administering neutralizing agents to blood samples, temporarily halting DOAC therapies prior to testing, or switching patients to low-molecular weight heparins—a practice requiring careful adherence to clinical judgment.
3. Effective Communication is Key:
Successful implementation of these strategies hinges on robust communication between laboratory professionals and clinicians. The expertise of both parties is crucial for determining the most effective tests and procedures tailored to individual patient needs.

Expert Insights

The document's authors, including notable figures such as Dr. Lindsay A.L. Bazydlo and Dr. Neil S. Harris, underscore the importance of conscientious decision-making when it comes to coagulation testing for patients on DOACs. They emphasize the necessity of engaging with laboratory leaders to understand current methodologies, enabling healthcare providers to make informed decisions about testing times and treatment.

"Clarity and collaboration are paramount in navigating coagulation testing for patients prescribed DOACs. Close consultation with lab staff ensures that testing protocols align with best practices, ultimately benefiting patient care,” stated Dr. Bazydlo.

Conclusion

The ADLM’s proactive approach reflects its commitment to improving health outcomes through laboratory medicine. By establishing clear guidelines on coagulation testing for blood thinner users, the organization not only enhances diagnostic accuracy but also places a strong emphasis on collaborative practices between healthcare providers and laboratories. For more information and to access the complete guidance document, visit ADLM's website.
With over 70,000 members across the globe, ADLM continues to advocate for advancements in laboratory practices, driving innovation and ensuring the highest standards of care in clinical settings.