Monitoring anticoagulants in the catheterization laboratory and in the ICU when using combination therapies

The availability of potent antiplatelet, antithrombin, and fibrinolytic therapies for the treatment of acute coronary syndromes (ACS) and during percutaneous coronary interventions (PCI) has made monitoring these therapies an important issue. The use of these agents in combination has led to improved antithrombotic efficacy, albeit at the cost of higher bleeding in some situations. Current and evolving technologies to monitor the extent of inhibition of platelet aggregation and activity of antithrombotic agents when used as combination therapy will be covered in this overview. Table 1 lists various scenarios in which the monitoring of combination therapies may be useful. The clinically important question to be considered is whether the results generated from monitoring will effect a change that will improve efficacy (prevent thrombotic events) or reduce adverse events (bleeding) from these therapies. Since novel and increasingly potent agents continue to be developed, monitoring anticoagulation will continue to be of special interest.