Tests available for patients on direct oral anticoagulants (DOACs) - dilute thrombin time

Principle

The dilute thrombin time (dTT) is a specific coagulation assay used to detect and quantify the presence of direct thrombin inhibitors (e.g. dabigatran) - relevant when assessing bleeding risk, guiding reversal, or confirming drug presence/absence in a patient on or suspected to be on a DOAC
Increasingly relevant given the widespread use of direct oral anticoagulants (DOACs), where standard coagulation tests (PT, APTT) are insensitive or unreliable for precisely quantifying drug level
Standard thrombin time is extremely sensitive to even trace direct thrombin inhibitor presence (too sensitive to be clinically useful for quantification, since it becomes markedly prolonged even at low drug levels) - the dilution of the reagent in the dTT specifically calibrates the assay to a clinically useful, quantifiable range for measuring dabigatran concentration specifically

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