Monitoring and pharmacokinetics of DOACs

Project managers

Dr W.M. Lijfering
Prof. dr Cannegieter
Dr F.J.M. van der Meer
Prof. dr M.V. Huisman


Leiden Anticoagulation Clinic and Department of Internal Medicine, LUMC


Direct oral anticoagulant drugs (DOACs) have recently been developed and marketed to be used in fixed dose regimens without the need for dose titration or monitoring of blood levels. This is considered to be a substantial advantage over vitamin K antagonists. However, it is doubtful as to whether pharmacokinetic profiles of DOACs are as stable as claimed, that ‘one size fits all’ and that they do not cause serious clinical events when not correctly used. This is certainly true for demanding drugs like DOACs, the efficacy of which will be affected by even one delayed or missed dose.

The overall objective of this project is to unravel treatment adherence, persistence and satisfaction patterns in patients who receive a DOAC (MONDOAC study). Furthermore, we will determine the within and between variability of pharmacokinetic (PK) profiles in patients treated with DOACs in daily practice (KIDOAC study).  

The MONDOAC and KIDOAC study will provide answers on why patients use or discontinue DOAC treatment, how that relates to patient outcomes including bleeding and stroke and whether the safety and efficacy of DOACs is likely to be improved by titration or monitoring of the DOAC treatment.