ArticleFrontiers in medicine2026
Monitoring anti-Xa levels and thromboelastography in puerperal venous thromboembolism: a prospective cohort study.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Postpartum venous thromboembolism (VTE) remains a clinical challenge despite thromboprophylaxis. Low molecular weight heparin (LMWH) represents the first-line treatment, but interindividual pharmacodynamic variability complicates dose titration. This study aimed to optimize individualized anticoagulation monitoring based on anti-Xa levels, thromboelastography (TEG) parameters, and biochemical parameters. Methods: This prospective cohort study included postpartum VTE patients treated with nadroparin at Shanghai First Maternity and Infant Hospital (September 2021-July 2022). Anti-Xa levels, TEG parameters, and coagulation indices were monitored over the initial 10 doses. Patients with peak anti-Xa levels of 0.5-1.0 IU/mL following the 4th dose were classified as the therapeutic group. All participants were followed for 1 year. Efficacy endpoints included anti-Xa levels, coagulation profiles, TEG changes, thrombus resolution, hospitalization duration, and VTE recurrence. Safety endpoints included bleeding, hematoma, prolonged lochia, thrombocytopenia, and skin reactions. Results: Fifty patients were enrolled. TEG parameters showed a biphasic response: R and K values peaked after four doses, then declined; MA, Angle, and CI exhibited inverse trends. Mean peak anti-Xa levels rose progressively from 0.05 ± 0.08 IU/mL (day 0), reaching 0.59 ± 0.19 IU/mL (day 5). Anti-Xa levels correlated positively with R ( Conclusion: Nadroparin shows a nonlinear dose-response in postpartum VTE. Anti-Xa levels and TEG correlations may enhance individualized anticoagulation monitoring strategies. Clinical trial registration: https://www.chictr.org.cn/bin/project/edit?pid=132010, ChiCTR2100051002.
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