In early 2018, the International Council for Standardization in Haematology (ICSH) published a guidance document for laboratories for direct oral anticoagulant (DOAC) measurements (Thromb Haemost 2018; 118(3):437-450). The document addressed the three phases related to coagulation testing: preanalytical, analytical and post-analytical. In addition, recommendations for method verification of performance we also included. However, in this rapidly changing field, additional issues related to DOAC treatment and laboratory measures were not addressed. The update ICSH document is intended to provide additional laboratory guidance related to new drug approvals (betrixaban), the impact of secondary drugs on DOAC testing results (e.g. LMWH and anti-Xa DOACs), addressing reversal strategies and their impact on DOAC testing (Praxbind, AndexXa), as well as new or modified (existing) DOAC measuring methods or devices.