{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T02:53:11Z","timestamp":1790477591279,"version":"4.1.0"},"reference-count":32,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Thromb Hemost"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Direct oral anticoagulants (DOACs) have largely replaced vitamin K antagonists owing to their predictable pharmacokinetics and improved safety. In emergency situations such as urgent surgery, major bleeding, or thrombolysis for acute ischemic stroke, rapid assessment of clinically relevant DOAC activity is essential. Conventional viscoelastic testing (VET) using devices such as ROTEM, TEG 5000, TEG6s, or ClotPro is insufficiently sensitive to detect DOACs, prompting the development of modified assays with specific activators. This systematic review summarizes recent advances in VET-based DOAC detection and evaluates the diagnostic performance of novel assay strategies and their correlation with plasma drug concentrations. A systematic search of PubMed and Google Scholar (January 2019\u2013June 2025) was conducted in accordance with PRISMA 2020 recommendations. Twelve of 113 identified studies met the inclusion criteria. Ecarin-based assays demonstrated 100% sensitivity and specificity for detecting the direct thrombin inhibitor dabigatran. For direct factor Xa inhibitors\u2014rivaroxaban, apixaban, and edoxaban\u2014modified assays using Russell's Viper Venom, factor Xa-based reagents, and low-tissue-factor activation showed variable but generally good correlations with drug levels (r\u2009=\u20090.571\u20130.969). Sensitivity was lower for apixaban (83\u201397%) than for rivaroxaban (90\u2013100%) and edoxaban (100%). Factor Xa-based and low-tissue-factor assays achieved sensitivities of 85 to 100% and specificities of 62 to 100%. In summary, modified VET assays show promise as rapid point-of-care tools for DOAC detection in emergency settings. Ecarin-based tests appear reliable for dabigatran, while Russell's Viper Venom and low-tissue-factor approaches may enable detection of direct factor Xa inhibitors. However, further clinical validation and standardization are required before routine implementation.<\/jats:p>","DOI":"10.1055\/a-2822-7599","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T23:43:56Z","timestamp":1773877436000},"page":"430-440","source":"Crossref","is-referenced-by-count":3,"title":["Advancing Point-of-Care Analysis: The Future of Thromboelastographic DOAC-Detection: A Systematic Review"],"prefix":"10.1055","volume":"52","author":[{"given":"Gerrit U.","family":"Herpertz","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Carl von Ossietzky Universit\u00e4t Oldenburg, Klinikum Oldenburg, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Altmann","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Carl von Ossietzky Universit\u00e4t Oldenburg, Klinikum Oldenburg, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Poli","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"Hertie Institute for Clinical Brain Research, University of T\u00fcbingen, T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon T.","family":"Sch\u00e4fer","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Carl von Ossietzky Universit\u00e4t Oldenburg, Klinikum Oldenburg, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"G Hindricks","year":"2021","journal-title":"Eur Heart J"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"1901647","DOI":"10.1183\/13993003.01647-2019","article-title":"2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)","volume":"54","author":"S V Konstantinides","year":"2019","journal-title":"Eur Respir J"},{"issue":"9921","key":"ref3","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/S0140-6736(13)62343-0","article-title":"Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials","volume":"383","author":"C T Ruff","year":"2014","journal-title":"Lancet"},{"issue":"14","key":"ref4","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1056\/NEJMoa1814051","article-title":"Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors","volume":"380","author":"S J Connolly","year":"2019","journal-title":"N Engl J Med"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.thromres.2022.05.010","article-title":"Effectiveness and safety of edoxaban therapy in daily-care patients with atrial fibrillation. Results from the DRESDEN NOAC REGISTRY","volume":"215","author":"C K\u00f6hler","year":"2022","journal-title":"Thromb Res"},{"issue":"10","key":"ref6","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1093\/europace\/euab065","article-title":"2021 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation","volume":"23","author":"J Steffel","year":"2021","journal-title":"Europace"},{"issue":"19","key":"ref7","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1056\/NEJMoa2313040","article-title":"Andexanet for factor Xa inhibitor-associated acute intracerebral hemorrhage","volume":"390","author":"S J Connolly","year":"2024","journal-title":"N Engl J Med"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1093\/ajcp\/aqad085","article-title":"One-year retrospective analysis of anti-FXa apixaban and rivaroxaban levels demonstrates utility for 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