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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.

Stay updated on all scientific advances with Hemostasis Today.

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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