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Expected effects of anticoagulant drugs on commonly used coagulation tests

Drug class	Drug	Brand name(s)	PT	aPTT	Anti-factor Xa activity
Vitamin K antagonists	Warfarin	Jantoven	↑	↑/– *	–
Vitamin K antagonists	Acenocoumarol	Sintrom	↑	↑/– *	–
Heparins	Unfractionated heparin		– ¶	↑	↑
	LMW heparins		–	↑/–	↑
	Enoxaparin	Lovenox
	Dalteparin	Fragmin
	Nadroparin	Fraxiparine
	Fondaparinux	Arixtra	–	↑/–	↑
Direct thrombin inhibitors	Argatroban	Acova	↑	↑	–
Direct thrombin inhibitors	Dabigatran	Pradaxa	↑/–	↑	–
Direct factor Xa inhibitors	Rivaroxaban	Xarelto	↑/–	↑/–	↑^Δ
	Apixaban	Eliquis	↑/–	↑/–	↑^Δ
	Edoxaban	Lixiana, Savaysa			↑^Δ

PT and aPTT are measured in seconds; anti-factor Xa activity is measured in units/mL. Upward arrow (↑) signifies an increase above normal due to the anticoagulant (prolongation of PT or aPTT; increase in anti-factor Xa activity). The effect magnitude will vary depending on the reagent formulation and instrument used. Dash (–) signifies no appreciable effect. Normal ranges for the PT, aPTT, and anti-factor Xa activity vary among laboratories and should be reported from the testing laboratory along with the patient result. Refer to the UpToDate topic on coagulation testing for details.

PT: prothrombin time; aPTT: activated partial thromboplastin time; LMW heparin: low molecular weight heparin.

* Warfarin has a weak effect on most aPTT reagents. However, warfarin use will increase the sensitivity of the aPTT to heparin effect.

¶ While heparin, LMW heparin, and fondaparinux should, in theory, prolong the PT as indirect thrombin inhibitors, in practice most PT reagents contain heparin-binding chemicals that block any heparin effect below a concentration of 1 unit/mL. Above concentrations of 1 unit/mL, heparin effect on the PT may be observed.

Δ Anti-factor Xa activity testing must be calibrated for the specific anticoagulant; this information should be verified with the clinical laboratory.

Some of the data are from: Samuelson BT, Cuker A, Crowther M, Garcia DA. Laboratory assessment of the anticoagulant activity of direct oral anticoagulants: A systematic review. Chest 2017; 151:127.

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