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Mohamed Sherif Salem: Anti-Xa Monitoring Did Not Reduce Bleeding or Thromboembolic Events
Mohamed Sherif Salem/LinkedIn
Nov 9, 2025, 11:35

Mohamed Sherif Salem: Anti-Xa Monitoring Did Not Reduce Bleeding or Thromboembolic Events

Mohamed Sherif Salem, Senior Clinical Pharmacist at Andalusia Health Egypt, shared on LinkedIn:

”A 2025 systematic review found that routine anti-factor Xa (anti-Xa) monitoring during therapeutic LMWH therapy led to more dose changes but did not reduce bleeding or thromboembolic events.

Study details:

  • Design: Systematic review (4 randomized trials + 44 observational studies; total 48 studies).
  • Key dataset: 30 studies ( >3,000 patients) evaluated the relationship between measured anti-Xa activity and bleeding risk.

Findings

  • Anti-Xa measurements prompted dose adjustments more frequently than no monitoring.
  • There was no reduction in clinical end points (major bleeding or thromboembolism) in monitored versus unmonitored groups.
  • Correlation between anti-Xa levels and bleeding (or thrombotic) outcomes was weak or absent in most studies.

Interpretation / practical implications:

  • Routine anti-Xa monitoring for patients on therapeutic LMWH cannot be recommended based on current evidence. The data support continuing fixed or weight-based dosing in typical patients.
  • Monitoring should be selective: consider anti-Xa measurement in patients where LMWH pharmacokinetics are likely unreliable (examples: significant renal impairment, extremes of body weight, ongoing active bleeding or when clinical management would change based on the result).”

Article: A systematic review on anti-Xa monitoring in the therapeutic use of low-molecular-weight heparins

Authors: Tessa C.C. Jaspers, P. Christian Remmelzwaal, Eefje P.S. Weersink, Karina Meijer, Nakisa Khorsand

Mohamed Sherif Salem

Read the full article here.

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anti-Xa Anticoagulation bleeding Eefje P.S. Weersink Health Hematology Hemostasis Today Karina Meijer LMWH Medicine Mohamed Sherif Salem Nakisa Khorsand P. Christian Remmelzwaal Tessa C.C. Jaspers Thromboembolic Events
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