College of American Pathologists Conference XXXI on Laboratory Monitoring of Anticoagulant Therapy: Future Directions

Heparin and warfarin have constituted the dominant modes of anticoagulation for more than 50 years. Consequently, laboratory monitoring strategies for anticoagulation monitoring have focused almost exclusively on these 2 agents. This situation is about to change! We are on the verge of spectacular growth and diversification of available therapeutic agents as a result of the past decade’s explosive growth in understanding molecular and cellular mechanisms of hemostasis and thrombosis. These new agents are targeted to modulate different biochemical pathways leading to thrombosis and include a wide assortment of highly selective antiproteases, numerous novel platelet inhibitors, and a number of novel variants of traditional agents, like low-molecular-weight heparin. On the thrombolytic side, there have been numerous new and highly targeted agents developed following the success of tissue plasminogen activator and streptokinase in the lysis of coronary thrombi in acute myocardial infarction. Many of these drugs have entered phase I and phase II clinical trials, and some are just now entering clinical practice. Unfortunately, a number of these new agents cannot be monitored with the tradi-