Dr. Nagalla on Need for Timely Assays for DOACs in MPNs

Srikanth Nagalla, MD, director of the Hematology Oncology Fellowship Program at Harold C. Simmons Comprehensive Cancer Center, and associate professor of medicine at UT Southwestern Medical Center, discusses research efforts dedicated to the development of timely assays for direct oral anticoagulants (DOACs) in myeloproliferative neoplasms (MPNs).

Investigators at UT Southwestern Medical Center are trying to get testing for DOACs. To have an assay for rivaroxaban (Xarelto) or apixaban (Eliquis) that could feasibly be performed in a more timely manner would be beneficial, says Nagalla.

Such assays could help inform treatment selection for patients better. Specifically, these assays could help inform more judicious use of some of the more expensive drugs, such as andexanet alfa (Ondexxya), ensuring that they’re only given in patients in whom we feel bleeding is mainly because of rivaroxaban, apixaban, or edoxaban (Savaysa), adds Nagalla.

That being said, if a patient is bleeding, it would be difficult to wait for assay results to come back; these tests could take at least 30 minutes and if someone is experiencing a brain bleed, treatment cannot wait, says Nagalla. As such, work is being done to improve turnaround times of such assays.

This work is necessary so that treatment can become more personalized for patients with MPNs, and thus more effective. Timely assays can ensure that newer drugs are used appropriately in the right patient population; these agents shouldn’t just be used in anyone who is taking a DOAC, as the DOAC may not even be the cause of current bleeding, concludes Nagalla.