{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:12:29Z","timestamp":1790079149148,"version":"4.0.1"},"reference-count":67,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hematol. Rep.","Hematology Reports"],"abstract":"<jats:p>Anticoagulant therapy has undergone substantial evolution over the past century, progressing from early parenteral agents such as heparin to vitamin K antagonists (VKAs) and, more recently, to direct oral anticoagulants (DOACs). This review provides an overview of the major classes of anticoagulants, including unfractionated heparin (UFH), low molecular weight heparin (LMWH), fondaparinux, direct thrombin inhibitors, VKAs, and DOACs, with emphasis on their mechanisms of action, clinical applications, laboratory monitoring, and reversal strategies. While UFH remains widely used in acute settings, its unpredictable pharmacokinetics and risk of heparin induced thrombocytopenia have led to increased use of LMWH and fondaparinux. VKAs, historically the cornerstone of oral anticoagulation, are limited by variable dosing requirements and the need for routine monitoring. In contrast, DOACs have transformed anticoagulation management through predictable pharmacokinetics, fixed dosing, and improved safety profiles, and are now first line therapies for several thromboembolic conditions. The development of targeted reversal agents, including protamine, vitamin K, prothrombin complex concentrates, idarucizumab, and andexanet alfa, has significantly enhanced the safety of anticoagulant therapy in the setting of major bleeding or urgent procedures. Laboratory assessment remains critical for selecting anticoagulants and evaluating clinical scenarios, with evolving roles for anti-Xa assays, thrombin-based assays, and mass spectrometry techniques. Emerging anticoagulants targeting factors XI, XII, and XIII represent a promising future direction with the potential to further reduce bleeding risk while maintaining efficacy. Overall, continued advances in anticoagulant pharmacology, monitoring, and reversal strategies are driving a shift toward safer and more individualized patient care.<\/jats:p>","DOI":"10.3390\/hematolrep18050067","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:21:48Z","timestamp":1790072508000},"page":"67","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anticoagulants, Their Laboratory Monitoring, and Reversal"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2761-4320","authenticated-orcid":false,"given":"Mohammad","family":"Barouqa","sequence":"first","affiliation":[{"name":"Department of Pathology, University of South Alabama, 2451 University Hospital Dr., Mobile, AL 36617, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2032-7356","authenticated-orcid":false,"given":"Marianne E.","family":"Yassa","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of South Alabama, 2451 University Hospital Dr., Mobile, AL 36617, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nestor","family":"Dela Cruz","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of South Alabama, 2451 University Hospital Dr., Mobile, AL 36617, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maha","family":"Babker","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of South Alabama, 2451 University Hospital Dr., Mobile, AL 36617, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1124\/pharmrev.122.000684","article-title":"Pharmacology of Heparin and Related Drugs: An Update","volume":"75","author":"Hogwood","year":"2023","journal-title":"Pharmacol. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1177\/0310057X251323777","article-title":"The history of warfarin","volume":"53","author":"Ball","year":"2025","journal-title":"Anaesth. Intensive Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.1503\/cmaj.111795","article-title":"Skill, drive and luck: The discovery and development of heparin","volume":"183","author":"Norman","year":"2011","journal-title":"Can. Med. Assoc. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1093\/europace\/euv030","article-title":"Anticoagulation reversal in the era of the non-vitamin K oral anticoagulants","volume":"18","author":"Enriquez","year":"2016","journal-title":"Europace"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Heestermans, M., Poenou, G., Hamzeh-Cognasse, H., Cognasse, F., and Bertoletti, L. (2022). Anticoagulants: A Short History, Their Mechanism of Action, Pharmacology, and Indications. Cells, 11.","DOI":"10.3390\/cells11203214"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1093\/toxsci\/66.1.4","article-title":"The Missing Link: The Story of Karl Paul Link","volume":"66","author":"Last","year":"2002","journal-title":"Toxicol. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1136\/heartjnl-2016-309266","article-title":"Warfarin utilisation and anticoagulation control in patients with atrial fibrillation and chronic kidney disease","volume":"103","author":"Yang","year":"2017","journal-title":"Heart"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"269","DOI":"10.4314\/gmj.v54i4.10","article-title":"Warfarin-induced skin necrosis: A rare condition","volume":"54","author":"Nsaful","year":"2020","journal-title":"Ghana Med. J."},{"key":"ref_9","first-page":"1016","article-title":"Chronic recurrent warfarin-induced skin necrosis in a patient with a mechanical mitral valve: A diagnostic mimic of pyoderma gangrenosum","volume":"12","author":"Magar","year":"2025","journal-title":"Int. Surg. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"7249","DOI":"10.1097\/MS9.0000000000003848","article-title":"Warfarin-induced skin necrosis: A narrative review of clinical features, risk factors, and treatment strategies","volume":"87","author":"Suliman","year":"2025","journal-title":"Ann. Med. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e24S","DOI":"10.1378\/chest.11-2291","article-title":"Parenteral Anticoagulants","volume":"141","author":"Garcia","year":"2012","journal-title":"Chest"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"McRae, H.L., Militello, L., and Refaai, M.A. (2021). Updates in Anticoagulation Therapy Monitoring. Biomedicines, 9.","DOI":"10.3390\/biomedicines9030262"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1055\/s-0036-1597297","article-title":"Laboratory Monitoring of Parenteral Direct Thrombin Inhibitors","volume":"43","author":"Roberts","year":"2017","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1177\/0885066621993739","article-title":"Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A Systematic Review","volume":"37","author":"Geli","year":"2022","journal-title":"J. Intensiv. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kholmukhamedov, A., Subbotin, D., Gorin, A., and Ilyassov, R. (2025). Anticoagulation Management: Current Landscape and Future Trends. J. Clin. Med., 14.","DOI":"10.3390\/jcm14051647"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1477-9560-11-10","article-title":"Rivaroxaban and other novel oral anticoagulants: Pharmacokinetics in healthy subjects, specific patient populations and relevance of coagulation monitoring","volume":"11","author":"Mueck","year":"2013","journal-title":"Thromb. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"459","DOI":"10.2478\/acph-2022-0034","article-title":"Direct oral anticoagulants (DOACs): From the laboratory point of view","volume":"72","author":"Goreta","year":"2022","journal-title":"Acta Pharm."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1177\/8755122518759765","article-title":"Betrixaban: A Novel Oral Anticoagulant with a New Niche","volume":"34","author":"Murphy","year":"2018","journal-title":"J. Pharm. Technol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s11239-016-1461-1","article-title":"Extended-duration versus short-duration pharmacological thromboprophylaxis in acutely Ill hospitalized medical patients: A systematic review and meta-analysis of randomized controlled trials","volume":"43","author":"Liew","year":"2017","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1161\/CIRCULATIONAHA.122.062353","article-title":"Pharmacology and Clinical Development of Factor XI Inhibitors","volume":"147","author":"Greco","year":"2023","journal-title":"Circulation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"76","DOI":"10.4081\/btvb.2023.76","article-title":"The new era of anticoagulation: Factor XI and XII inhibitors","volume":"2","author":"Prisco","year":"2023","journal-title":"Bleeding Thromb. Vasc. Biol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1016\/S0049-3848(16)30363-2","article-title":"Factor XI and factor XII as targets for new anticoagulants","volume":"141","author":"Weitz","year":"2016","journal-title":"Thromb. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40119-024-00352-x","article-title":"Factor XI Inhibitors: A New Horizon in Anticoagulation Therapy","volume":"13","author":"Presume","year":"2024","journal-title":"Cardiol. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1182\/blood.2024025321","article-title":"Factor XIII: Driving (cross-)links in hemostasis, thrombosis, and disease","volume":"146","author":"Luyendyk","year":"2025","journal-title":"Blood"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1056\/NEJMoa2113194","article-title":"Milvexian for the Prevention of Venous Thromboembolism","volume":"385","author":"Weitz","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Ruseska, I., Fresacher, K., Petschacher, C., and Zimmer, A. (2021). Use of Protamine in Nanopharmaceuticals-A Review. Nanomaterials, 11.","DOI":"10.3390\/nano11061508"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1016\/j.jtha.2023.04.005","article-title":"What\u2019s fishy about protamine? Clinical use, adverse reactions, and potential alternatives","volume":"21","author":"Levy","year":"2023","journal-title":"J. Thromb. Haemost."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1007\/s00216-010-4220-8","article-title":"Protamine neutralisation of low molecular weight heparins and their oligosaccharide components","volume":"399","author":"Schroeder","year":"2011","journal-title":"Anal. Bioanal. Chem."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1213\/ane.0b013e3181602e0d","article-title":"Anaphylaxis during cardiac surgery: Implications for clinicians","volume":"106","author":"Levy","year":"2008","journal-title":"Anesth. Analg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1002\/j.1875-9114.2011.01049.x","article-title":"Antifactor Xa Levels versus Activated Partial Thromboplastin Time for Monitoring Unfractionated Heparin","volume":"32","author":"Vandiver","year":"2012","journal-title":"Pharmacother. J. Hum. Pharmacol. Drug Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1111\/bjh.19729","article-title":"Measurement of heparin, direct oral anti-coagulants and other non-coumarin anti-coagulants and their effects on haemostasis assays: A British Society for Haematology Guideline","volume":"205","author":"Baker","year":"2024","journal-title":"Br. J. Haematol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"305","DOI":"10.4037\/aacnacc2019771","article-title":"Monitoring Unfractionated Heparin: A Review of Activated Partial Thromboplastin Time Versus Antifactor Xa","volume":"30","author":"Parker","year":"2019","journal-title":"AACN Adv. Crit. Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1177\/108925320300700403","article-title":"Devices for Monitoring Heparin and Protamine in the Operating Room","volume":"7","author":"Santrach","year":"2003","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1002\/ajh.25852","article-title":"Ecarin based coagulation testing","volume":"95","author":"Gosselin","year":"2020","journal-title":"Am. J. Hematol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1093\/ajcp\/aqad117","article-title":"Performance evaluation of heparin-induced platelet aggregation vs. serotonin release assay","volume":"161","author":"Barouqa","year":"2024","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1055\/s-0036-1597758","article-title":"Initiating and Managing Patients with Venous Thromboembolism on Anticoagulant Drugs: A Practical Overview","volume":"34","author":"Kasthuri","year":"2017","journal-title":"Semin. Interv. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Margraf, D.J., Seaburg, S., Beilman, G.J., Wolfson, J., Gipson, J.C., and Chapman, S.A. (2020). Propensity score adjusted comparison of three-factor versus four-factor prothrombin complex concentrate for emergent warfarin reversal: A retrospective cohort study. BMC Emerg. Med., 20.","DOI":"10.1186\/s12873-020-00386-z"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/1076029616674825","article-title":"Characterizing the Severe Reactions of Parenteral Vitamin K1","volume":"24","author":"Britt","year":"2018","journal-title":"Clin. Appl. Thromb.\/Hemost."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1111\/jth.13212","article-title":"Dose-associated pulmonary complication rates after fresh frozen plasma administration for warfarin reversal","volume":"14","author":"Marshall","year":"2016","journal-title":"J. Thromb. Haemost."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1586\/14737167.2015.1071194","article-title":"Prevention of treatment-related fluid overload reduces estimated effective cost of prothrombin complex concentrate in patients requiring rapid vitamin K antagonist reversal","volume":"16","author":"Jones","year":"2016","journal-title":"Expert Rev. Pharmacoecon. Outcomes Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"36","DOI":"10.4103\/IJCIIS.IJCIIS_40_17","article-title":"Three-versus four-factor prothrombin complex concentrate for the reversal of warfarin-induced bleeding","volume":"8","author":"Holt","year":"2018","journal-title":"Int. J. Crit. Illn. Inj. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Margraf, D.J., Brown, S.J., Blue, H.L., Bezdicek, T.L., Wolfson, J., and Chapman, S.A. (2022). Comparison of 3-factor versus 4-factor prothrombin complex concentrate for emergent warfarin reversal: A systematic review and meta-analysis. BMC Emerg. Med., 22.","DOI":"10.1186\/s12873-022-00568-x"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1177\/1060028020920855","article-title":"Emergent Warfarin Reversal with Fixed-Dose 4-Factor Prothrombin Complex Concentrate","volume":"54","author":"Jansma","year":"2020","journal-title":"Ann. Pharmacother."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ng, J.X., Tan, S.C., Koh, P.L., and Yap, E.S. (2026). Anticoagulation Stewardship Program in the DOAC Era. J. Clin. Med., 15.","DOI":"10.3390\/jcm15072597"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1055\/s-0036-1587690","article-title":"Laboratory Monitoring of Oral Vitamin K Anticoagulation","volume":"43","author":"Moffat","year":"2016","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1007\/s11239-021-02566-5","article-title":"Extending INR testing intervals in warfarin patients at a multi-center anticoagulation clinic","volume":"53","author":"Papala","year":"2022","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1111\/jth.14150","article-title":"Extended International Normalized Ratio testing intervals for warfarin-treated patients","volume":"16","author":"Barnes","year":"2018","journal-title":"J. Thromb. Haemost."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1177\/1076029617752247","article-title":"Prospective Comparison of Point-of-Care Device and Standard Analyzer for Monitoring of International Normalized Ratio in Outpatient Oral Anticoagulant Clinic","volume":"24","author":"Moiz","year":"2018","journal-title":"Clin. Appl. Thromb.\/Hemost."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s12959-023-00452-z","article-title":"Current and future strategies to monitor and manage coagulation in ECMO patients","volume":"21","author":"Carberry","year":"2023","journal-title":"Thromb. J."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Aldhaeefi, M., Badreldin, H.A., Alsuwayyid, F., Alqahtani, T., Alshaya, O., Al Yami, M.S., Bin Saleh, K., Al Harbi, S.A., and Alshaya, A.I. (2023). Practical Guide for Anticoagulant and Antiplatelet Reversal in Clinical Practice. Pharmacy, 11.","DOI":"10.3390\/pharmacy11010034"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1076029619895120","DOI":"10.1177\/1076029619895120","article-title":"Assay-Based Differentiation in the Neutralization Profile of Unfractionated Heparin, Enoxaparin, and Fondaparinux by Andexanet Alfa","volume":"26","author":"Siddiqui","year":"2020","journal-title":"Clin. Appl. Thromb.\/Hemost."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.5858\/2004-128-1142-EOPFAD","article-title":"Effects of pentasaccharide (fondaparinux) and direct thrombin inhibitors on coagulation testing","volume":"128","author":"Gosselin","year":"2004","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Avecilla, S.T., and Gil, M.R. (2025). Laboratory Monitoring for Heparins, Fondaparinux, Direct Thrombin Inhibitors, and Oral Anti-Xa Medications. Transfusion Medicine and Hemostasis [Internet], Elsevier. Available online: https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/B9780323960144000938.","DOI":"10.1016\/B978-0-323-96014-4.00093-8"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1097\/EJA.0000000000001968","article-title":"Clinical guideline on reversal of direct oral anticoagulants in patients with life threatening bleeding","volume":"41","author":"Grottke","year":"2024","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"141","DOI":"10.2147\/JBM.S121550","article-title":"Reversing factor Xa inhibitors\u2014Clinical utility of andexanet alfa","volume":"8","author":"Kaatz","year":"2017","journal-title":"J. Blood Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1056\/NEJMoa1607887","article-title":"Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors","volume":"375","author":"Connolly","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2413","DOI":"10.1056\/NEJMoa1510991","article-title":"Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity","volume":"373","author":"Siegal","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Dunois, C. (2021). Laboratory Monitoring of Direct Oral Anticoagulants (DOACs). Biomedicines, 9.","DOI":"10.3390\/biomedicines9050445"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1002\/phar.1884","article-title":"Laboratory and Clinical Monitoring of Direct Acting Oral Anticoagulants: What Clinicians Need to Know","volume":"37","author":"Conway","year":"2017","journal-title":"Pharmacother. J. Hum. Pharmacol. Drug Ther."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"10760296241241524","DOI":"10.1177\/10760296241241524","article-title":"Challenges to Laboratory Monitoring of Direct Oral Anticoagulants","volume":"30","author":"Qiao","year":"2024","journal-title":"Clin. Appl. Thromb."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.chest.2016.08.1462","article-title":"Laboratory Assessment of the Anticoagulant Activity of Direct Oral Anticoagulants","volume":"151","author":"Samuelson","year":"2017","journal-title":"Chest"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.thromres.2024.04.005","article-title":"Is there a role for the laboratory monitoring in the management of specific antidotes of direct oral anticoagulants?","volume":"237","author":"Gendron","year":"2024","journal-title":"Thromb. Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1093\/eurheartj\/ehad123","article-title":"Reversal agents for current and forthcoming direct oral anticoagulants","volume":"44","author":"Weitz","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1182\/asheducation.V2015.1.117.3916182","article-title":"Monitoring and reversal of direct oral anticoagulants","volume":"2015","author":"Cuker","year":"2015","journal-title":"Hematol. Am. Soc. Hematol. Educ. Program."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e017559","DOI":"10.1161\/JAHA.120.017559","article-title":"Direct Oral Anticoagulant Use: A Practical Guide to Common Clinical Challenges","volume":"9","author":"Chen","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1016\/j.jacc.2019.08.1031","article-title":"Anticoagulation in Concomitant Chronic Kidney Disease and Atrial Fibrillation","volume":"74","author":"Kumar","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1097\/MNH.0000000000000634","article-title":"Direct oral anticoagulants in chronic kidney disease: An update","volume":"29","author":"Mavrakanas","year":"2020","journal-title":"Curr. Opin. Nephrol. Hypertens."}],"container-title":["Hematology Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2038-8330\/18\/5\/67\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:38:28Z","timestamp":1790077108000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2038-8330\/18\/5\/67"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,20]]},"references-count":67,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["hematolrep18050067"],"URL":"https:\/\/doi.org\/10.3390\/hematolrep18050067","relation":{},"ISSN":["2038-8330"],"issn-type":[{"value":"2038-8330","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,20]]}}}