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Journal articles on the topic 'Anti-Xa levels'

Author: Grafiati

Published: 2 June 2025

Last updated: 31 July 2025

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1

Kufel, Wesley D., Robert W. Seabury, William Darko, Luke A. Probst, and Christopher D. Miller. "Clinical Feasibility of Monitoring Enoxaparin Anti-Xa Concentrations: Are We Getting it Right?" Hospital Pharmacy 52, no. 3 (2017): 214–20. http://dx.doi.org/10.1310/hpj5203-214.

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Background Anti-Xa monitoring is utilized to measure the extent of anticoagulation in certain patient populations receiving enoxaparin. It is essential to accurately obtain this pharmacodynamic marker for safe and effective anticoagulation management. Objectives To determine the frequency of correctly drawn anti-Xa concentrations in accordance with predefined institutional criteria and to determine the number of dose adjustments implemented based on incorrectly drawn anti-Xa concentrations. Methods This was a retrospective, single-center, cohort study among adult patients who received treatmen

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Perkins, Louis, Laura Adams, Dmitri Lerner, Jarrett Santorelli, Alan M. Smith, and Leslie Kobayashi. "Predictors of direct oral anticoagulant concentrations in the trauma population." Trauma Surgery & Acute Care Open 9, no. 1 (2024): e001208. http://dx.doi.org/10.1136/tsaco-2023-001208.

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IntroductionDirect oral anticoagulant (DOAC) use is becoming more prevalent in patients presenting after trauma. We sought to identify the prevalence and predictors of subtherapeutic and therapeutic DOAC concentrations and hypothesized that increased anti-Xa levels would correlate with increased risk of bleeding and other poor outcomes.MethodsA retrospective cohort study of all trauma patients on apixaban or rivaroxaban admitted to a level 1 trauma center between January 2015 and July 2021 was performed. Patients were excluded if they did not have a DOAC-specific anti-Xa level at presentation.

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Fung, Lela S., and Christopher Klockau. "Effects of Age and Weight-Based Dosing of Enoxaparin on Anti-Factor Xa Levels In Pediatric Patients." Journal of Pediatric Pharmacology and Therapeutics 15, no. 2 (2010): 119–25. http://dx.doi.org/10.5863/1551-6776-15.2.119.

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ABSTRACT OBJECTIVE The objective of this dose range study is to expand on the relationship between age and weight-based doses of enoxaparin and resulting levels of anti-factor Xa (anti-Xa) in pediatric patients. The primary outcome of this study is to determine the average dose of enoxaparin required to produce a therapeutic effect. Secondary outcomes include the number of enoxaparin dose changes required to achieve a therapeutic level of anti-Xa in each age group, the success rates of achieving and maintaining therapeutic anti-Xa levels, and the effect of serum antithrombin concentrations on

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Kuitunen, Anne, Jari Petäjä, Sorella Ilveskero, Riitta Lassila, and Peter Raivio. "Monitoring high-dose heparinization during cardiopulmonary bypass – A comparison between prothrombinase-induced clotting time (PiCT) and two chromogenic anti-factor Xa activity assays." Thrombosis and Haemostasis 99, no. 02 (2008): 427–34. http://dx.doi.org/10.1160/th07-04-0307.

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SummaryHeparinization requires monitoring, but optimal methods for measuring the anticoagulant effects of heparin remain to be determined. We compared prothrombinase-induced clotting time (PiCT) and two chromogenic anti-factor Xa activity (anti-Xa) assays in monitoring high-dose heparinization during cardiopulmonary by-pass (CPB). Heparin effects were serially measured with PiCT and two anti-Xa assays in 100 patients. Antithrombin and protein C activities were measured preoperatively, and antithrombin activity was measured during CPB. Activation of coagulation was assessed with measurements of

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Huh, Jin-Hyeun, Derek Leong, Maxine Lau, and Maja Gavrilovic. "Validation of a Weight Based Heparin Nomogram That Utilizes Anti-Factor Xa Levels for Monitoring." Blood 108, no. 11 (2006): 4114. http://dx.doi.org/10.1182/blood.v108.11.4114.4114.

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Abstract PURPOSE: This study documented consecutive patients receiving continous intravenous (IV)unfractioned heparin(UFH) infusion during the introduction of an Anti-Xa level and weight based nomogram to evaluate 1)the ability of the new nomogram to achieve a therapeutic Anti-Xa level with the first level drawn. 2) the ability of the new nomogram to achieve Anti-Xa levels within the therapeutic range by 24 hours from initiation. After review of the current literature, the therapeutic anti-Xa level were defined as 0.4–0.6 and 0.4–0.5 for standard and low dose anticoagulation respectively. METH

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Wahking, Rebekah A., Rachel H. Hargreaves, Sean M. Lockwood, Sabrina K. Haskell, and Kelly W. Davis. "Comparing Anti–Factor Xa and Activated Partial Thromboplastin Levels for Monitoring Unfractionated Heparin." Annals of Pharmacotherapy 53, no. 8 (2019): 801–5. http://dx.doi.org/10.1177/1060028019835202.

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Background: Lab tests such as activated partial thromboplastin time (aPTT) or anti–factor Xa (anti-Xa) levels are typically used to monitor intravenous unfractionated heparin (IV heparin), with recent evidence suggesting that anti-Xa levels may provide a more accurate measure of anticoagulation. Objective: The Lexington Veterans Affairs Health Care System transitioned from using aPTT to anti-Xa levels in January 2017. This study was conducted to evaluate the efficacy and safety of this change. Methods: This was a retrospective cohort study comparing all patients receiving IV heparin per protoc

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Levine, Mark, Michael Keeney, Karen MacKinnon, Agnes Lee, and Michael Kovacs. "Anti-Xa effect of a low molecular weight heparin (dalteparin) does not accumulate in extended duration therapy for venous thromboembolism in cancer patients." Thrombosis and Haemostasis 93, no. 06 (2005): 1185–88. http://dx.doi.org/10.1160/th05-01-0052.

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SummaryMany patients with venous thromboembolism are being treated with low molecular weight heparin for extended periods of time. It is not certain if it is necessary to assess anti-Xa levels for extended treatment periods. This study is a prospective assessment of anti-Xa levels in patients on long-term therapy for acute venous thromboembolism who have active cancer. Consecutive consenting patients from one center in a multicenter trial that compared 6 months of low molecular weight heparin with oral anticoagulant therapy were treated with therapeutic doses of dalteparin (200 IU per kilogram

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8

Niziolek, Grace Martin, Lauren Mangan, Cassidi Weaver, et al. "Inadequate prophylaxis in patients with trauma: anti-Xa-guided enoxaparin dosing management in critically ill patients with trauma." Trauma Surgery & Acute Care Open 9, no. 1 (2024): e001287. http://dx.doi.org/10.1136/tsaco-2023-001287.

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IntroductionVenous thromboembolism (VTE) causes significant morbidity in patients with trauma despite advances in pharmacologic therapy. Prior literature suggests standard enoxaparin dosing may not achieve target prophylactic anti-Xa levels. We hypothesize that a new weight-based enoxaparin protocol with anti-Xa monitoring for dose titration in critically injured patients is safe and easily implemented.MethodsThis prospective observational study included patients with trauma admitted to the trauma intensive care unit (ICU) from January 2021 to September 2022. Enoxaparin dosing was adjusted bas

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Effendi, Muhammad, Martha Stutsky, Caleigh A. Curran, Kent A. Owusu, and Alfred Ian Lee. "Impact of a Pharmacist Driven Anti-Xa Level Monitoring Protocol on Therapeutic Drug Monitoring Practice Patterns." Blood 132, Supplement 1 (2018): 2284. http://dx.doi.org/10.1182/blood-2018-99-119379.

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Abstract Introduction: Low molecular weight heparin (LMWH) has a favorable pharmacokinetic profile which precludes the need for routine laboratory monitoring. However, certain patient populations, including those with extreme body weight (overweight or underweight), renal dysfunction, history of bleeding event while receiving LMWH, or previous failure of therapy, may benefit from therapeutic monitoring. Suboptimal drug monitoring of enoxaparin due to incorrect timing of anti-Xa levels, delayed blood sample draws, and/or lack of follow up once the anti-Xa level has resulted has been documented

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Papadakis, Ioannis, Andria Papazachariou, Aikaterini Charizani, et al. "INFLUENCE OF VARIOUS FACTORS ON ANTI-XA LEVELS IN HOSPITALIZED MEDICAL PATIENTS RECEIVING PARENTERAL THROMBOPROPHYLAXIS." Journal of Hypertension 42, Suppl 1 (2024): e274. http://dx.doi.org/10.1097/01.hjh.0001022320.69726.4c.

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Objective: Venous thromboembolism (VTE) stands as a prevalent vascular disease, intimately linked to increased risk for morbidity and mortality. The aim of this study was to investigate the influence of various factors on anti-Xa levels in hospitalized medical patients receiving parenteral thromboprophylaxis. Design and method: This is a single-center cohort study encompassing patients admitted to the Internal Medicine Department of the University Hospital of Heraklion, from March to August 2023. These patients were placed on thromboprophylaxis due to a heightened risk of developing VTE. Data

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Ireland, Helen, D. A. Lane, Angela Flynn, E. Anastassiades, and J. R. Curtis. "The Anticoagulant Effect of Heparinoid Org 10172 During Haemodialysis: An Objective Assessment." Thrombosis and Haemostasis 55, no. 02 (1986): 271–75. http://dx.doi.org/10.1055/s-0038-1661535.

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SummaryThe heparinoid of natural origin Org 10172 has anti-factor Xa activity but minimal anti-thrombin activity, and little effect upon broad spectrum assays such as the KCCT in vitro. Its anticoagulant effects have been compared to those of commercial heparin in 7 patients undergoing haemodialysis for chronic renal failure. Commercial heparin was administered in a dose (5,000 iu bolus + 1,500 iu/hour continuous iv infusion) previously shown to inhibit fibrin formation during haemodialysis. This produced mean anti-factor Xa levels in plasma between 0.7-1.0 iu/ml and largely suppressed fibrin

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12

Opoku, Akwasi, Kenneth Iwuji, Brendon Clough, et al. "Discordance between aPTT and anti-factor Xa levels and implications in patients receiving intravenous unfractionated heparin therapy." Southwest Respiratory and Critical Care Chronicles 7, no. 30 (2019): 12–18. http://dx.doi.org/10.12746/swrccc.v7i30.559.

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Heparin, one of the world’s oldest anticoagulation medications, accelerates the rate ofinhibition of previously activated clotting factors. It is most often used in the prophylaxis andtreatment of thromboembolic disorders and complications associated with atrial fibrillation.The two most common ways to monitor plasma heparin levels and anticoagulation therapyare the activated partial thromboplastin time (aPTT) and anti-factor Xa assay (anti-Xa). Thisarticle assesses the performance of aPTT and anti-Xa monitoring protocols and analyzes thediscordance between aPTT and anti-Xa levels and its clin

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Levine, M. N., A. Planes, J. Hirsh, M. Goodyear, N. Vochelle, and M. Gent. "The Relationship between Anti-Factor Xa Level and Clinical Outcome in Patients Receiving Enoxaparine Low Molecular Weight Heparin to Prevent Deep Vein Thrombosis after Hip Replacement." Thrombosis and Haemostasis 62, no. 03 (1989): 940–44. http://dx.doi.org/10.1055/s-0038-1651032.

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SummaryStudies in experimental animals have demonstrated that there is a relationship between levels of low molecular weight (LMW) heparin and both bleeding and inhibition of thrombosis. The relationship between these outcomes and ex vivo anti-factor Xa levels has been examined in 163 patients undergoing total hip replacement who were given prophylaxis once daily with a LMW heparin (enoxaparine). Fifty patients received 60 mg of enoxaparine and 113 received 40 mg, both regimens being administered subcutaneously once daily. Blood samples for anti-factor Xa levels were collected 12 hours after t

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Bookstaver, David A., Kimberly Sparks, Brandon S. Pybus, Dustin K. Davis, Sean R. Marcsisin, and Jason C. Sousa. "Comparison of Anti-Xa Activity in Patients Receiving Apixaban or Rivaroxaban." Annals of Pharmacotherapy 52, no. 3 (2017): 251–56. http://dx.doi.org/10.1177/1060028017738262.

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Background: There is no established method for monitoring the anticoagulant effects of apixaban and rivaroxaban. Linear correlation between serum levels and anti-Xa activity has been shown, with r2 ranging from 0.88 to 0.99. However, there are minimal data in patients receiving apixaban 5 mg twice daily or rivaroxaban 20 mg once daily. Objective: To evaluate the anti-Xa activity and serum levels at those doses and compare the trough anti-Xa activity. Methods: This was a single-center prospective study,approved by the institutional review board. Patients on an inappropriate dose or receiving an

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Stutsky, Martha E., David P. Reardon, and Alfred I. Lee. "Clinical Practice Patterns of Anti-Xa Monitoring During Low Molecular Weight Heparin Therapy." Blood 126, no. 23 (2015): 3275. http://dx.doi.org/10.1182/blood.v126.23.3275.3275.

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Abstract Introduction: Therapeutic low molecular weight heparin (LMWH) regimens were developed empirically based on patient weight and renal function without the need for laboratory monitoring. The role of anti-Xa monitoring for patients receiving LMWH has yet to be fully established and is routinely performed only in high risk patients. At our institution, guidelines for monitoring LMWH recommend drawing anti-Xa levels for patients with chronic kidney disease or those with obesity requiring long-term therapy. The purpose of this analysis was to evaluate compliance with institutional guideline

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Dinh, Christine Nguyen, Brady S. Moffett, Marianne Galati, YoungNa Lee-Kim, Donald L. Yee, and Donald Mahoney. "A Critical Evaluation of Enoxaparin Dose Adjustment Guidelines in Children." Journal of Pediatric Pharmacology and Therapeutics 24, no. 2 (2019): 128–33. http://dx.doi.org/10.5863/1551-6776-24.2.128.

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OBJECTIVES The purposes of this study are to perform a large-scale evaluation of the standardized dosage adjustment nomogram recommended by the American College of Chest Physicians (CHEST) for the management of enoxaparin in hospitalized pediatric patients and to determine the necessity of routine and repeated anti–factor Xa (anti-Xa) levels. METHODS A retrospective cohort study was designed, and charts were reviewed in a single tertiary care institution for all patients who received enoxaparin between October 1, 2010, through September 30, 2016. Patients were included if they were receiving t

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Fan, Jennifer L., Laura E. Roberts, Mona D. Shah, and YoungNa J. Lee-Kim. "Association of Outcomes and Anti-Xa Monitoring in Treatment of Pediatric Venous Thromboembolism." Blood 126, no. 23 (2015): 2330. http://dx.doi.org/10.1182/blood.v126.23.2330.2330.

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Abstract BACKGROUND/INTRODUCTION: With the increased use of venous catheters and improved survival from previously life-threatening pediatric disorders (e.g., congenital heart disease, cancer), the incidence of venous thromboembolism and the need for anticoagulation have also increased.While unfractionated heparin and warfarin were once considered the standards of care, enoxaparin has now become the drug of choice in many pediatric institutions, given improved efficacy, fewer bleeding complications, minimal interaction with concurrent medications, and a more favorable pharmacokinetic profile.

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Boyd, Allison, Todd Walroth, Brett Hartman, et al. "742 Evaluation of Anti-Xa Levels and Venous Thromboembolism Prophylaxis with Enoxaparin in Burn Patients." Journal of Burn Care & Research 44, Supplement_2 (2023): S152. http://dx.doi.org/10.1093/jbcr/irad045.216.

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Abstract Introduction Previous studies have found that standard dose enoxaparin is inadequate in achieving goal prophylactic anti-Xa levels in burn patients. A new venous thromboembolism (VTE) prophylaxis protocol was implemented at our institution (Table 1). The objective of this study was to assess the efficacy and safety of the updated VTE prophylaxis protocol to determine if goal anti-Xa levels can be achieved earlier compared to the previous enoxaparin dosing protocol. Methods This was a retrospective cohort study evaluating a historic protocol group from 3/1/21 to 5/31/21 and a new proto

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Nguyen, Tung Phi, Xuan Thi Phan, Dai Quang Huynh, et al. "Monitoring Unfractionated Heparin in Adult Patients Undergoing Extracorporeal Membrane Oxygenation (ECMO): ACT, APTT, or ANTI-XA?" Critical Care Research and Practice 2021 (May 3, 2021): 1–7. http://dx.doi.org/10.1155/2021/5579936.

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Background. During ECMO, anticoagulants, in particular, unfractionated heparin (UFH), are commonly used and monitored by laboratory tests, including ACT, APTT, and anti-Xa level. Method. A single-center retrospective observational study was conducted on adult patients undergoing ECMO between January 2019 and January 2020 at a tertiary hospital. The correlations between ACT, APTT, anti-Xa, antithrombin, and UFH dose were assessed. Results. 129 sets of measurements from 37 patients were obtained including ACT, APTT, anti-Xa, antithrombin, and UFH dose measured simultaneously. 102 out of 129 sets

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Dhillon, Navpreet K., Yassar M. Hashim, Naomi Berezin, et al. "Characterizing the delays in adequate thromboprophylaxis after TBI." Trauma Surgery & Acute Care Open 6, no. 1 (2021): e000686. http://dx.doi.org/10.1136/tsaco-2021-000686.

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BackgroundWe sought to compare enoxaparin dosing for venous thromboembolism (VTE) prophylaxis in trauma patients with and without traumatic brain injury (TBI) to better understand the time and dose required to reach target anti-Xa levels. Our hypothesis was that patients with TBI have significant delays in the initiation of adequate pharmacological prophylaxis and require a higher enoxaparin dose than currently recommended.MethodsThe medical records of trauma patients who received enoxaparin dosing based on anti-Xa trough levels between August 2014 and October 2016 were reviewed. Patients were

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Omran, Heyder, Christian Tripp, Bernd Poetzsch, and Christoph Hammerstingl. "How useful is determination of anti-factor Xa activity to guide bridging therapy with enoxaparin?" Thrombosis and Haemostasis 101, no. 02 (2009): 325–32. http://dx.doi.org/10.1160/th08-05-0280.

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SummaryLow-molecular-weight heparins (LMWH) are commonly used as peri-procedural bridging anticoagulants. The usefulness of measurement of anti-factor Xa activity (anti-Xa) to guide bridging therapy with LMWH is unknown. It was the objective of this study to determine levels of anti-Xa during standard bridging therapy with enoxaparin, and to examine predictors for residual anti-Xa. Consecutive patients receiving enoxaparin at a dosage of 1 mg/kg body weight/12 hours for temporary interruption of phenprocoumon were prospectively enrolled to the study. Blood-samples were obtained 14 hours after

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Maclachlan, Kylee H., Hannah P. Stevens, Sanjeev D. Chunilal, and Huyen A. Tran. "Weight-Based Enoxaparin Dosing for Venous Thromboembolism (VTE) >100kg Gives Similar Anti-Xa Levels to Patients <100kg, with No Increase in Bleeding." Blood 132, Supplement 1 (2018): 5059. http://dx.doi.org/10.1182/blood-2018-99-112021.

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Abstract Background: In clinical trials assessing venous thromboemobolism (VTE) management, patients with obesity are under-represented or specifically excluded. The International Society on Thrombosis and Haemostasis advises against direct-acting oral anticoagulants in patients >120kg(1). Therefore, low-molecular weight heparin and warfarin remain the standard of care in this population. Objective : To assess weight-based enoxaparin dosing in VTE, with no capping of prescribed doses, comparing patients weighing >100kg with those weighing <100kg. The primary outcome was anti-Xa activi

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Stevens, Hannah, Huyen Tran, Sanjeev Chunilal, and Kylee Maclachlan. "Weight-Based Enoxaparin for Venous Thromboembolism in Obesity Gives Similar Anti-Xa Levels to Patients <100 kg, with No Increase in Major Bleeding." Seminars in Thrombosis and Hemostasis 45, no. 01 (2019): 094–99. http://dx.doi.org/10.1055/s-0038-1677019.

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AbstractIn trials assessing venous thromboembolism (VTE) treatment, obese patients are under-represented or excluded. The main objective of this article is to examine the safety of weight-based enoxaparin dosing in obesity, as assessed by anti-factor Xa (anti-Xa) activity, bleeding, and recurrence. A 5-year retrospective audit of patients with acute VTE, weighing > 100 kg, prescribed enoxaparin 1 mg/kg twice daily, with an anti-Xa level 2 to 6 hours post-dose. The primary outcome was anti-Xa levels, and the secondary outcomes were bleeding and recurrence. Results were compared with patients

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Monteagudo-Vela, María, Christopher Bowles, Binu Raj, Derek Robinson, and Andre Simon. "Anticoagulation in syncardia total artificial heart recipients: anti-factor Xa or activated partial thromboplastin time?" Interactive CardioVascular and Thoracic Surgery 34, no. 2 (2021): 322–25. http://dx.doi.org/10.1093/icvts/ivab251.

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Abstract Although the activated partial thromboplastin time (aPTT) has historically been the method of choice for anticoagulation monitoring in patients undergoing mechanical circulatory support with intravenous unfractionated heparin, it is being progressively superseded by the anti-factor Xa (anti-Xa) method. A retrospective single-arm, single-centre analysis of 20 patients who underwent total artificial heart implantation entailed simultaneous determinations of aPTT and anti-Xa. Agreement between these parameters was assessed using the Bland–Altman method. Despite a positive correlation bet

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Gosselin, Robert C., Dorothy M. (Adcock) Funk, J. Michael Taylor, et al. "Comparison of Anti-Xa and Dilute Russell Viper Venom Time Assays in Quantifying Drug Levels in Patients on Therapeutic Doses of Rivaroxaban." Archives of Pathology & Laboratory Medicine 138, no. 12 (2014): 1680–84. http://dx.doi.org/10.5858/arpa.2013-0750-oa.

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Context Rivaroxaban is a new oral anticoagulant that functions as a direct anti-Xa inhibitor. Although routine monitoring is not required, measurement of plasma concentrations may be necessary in certain clinical situations. Routine coagulation assays, such as the prothrombin time and, to a lesser degree, activated partial thromboplastin time, correlate with drug concentration, but because of reagent variability, these methods are not reliable for determining rivaroxaban anticoagulation. Objective To compare different methods and calibrators for measuring rivaroxaban, including the chromogenic

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Gaze, Sian, Falak Latif, and Kim Wolff. "P004 An evaluation of the management of thrombosis in neonates and infants using dalteparin." Archives of Disease in Childhood 104, no. 7 (2019): e2.6-e2. http://dx.doi.org/10.1136/archdischild-2019-nppc.14.

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AimTo assess the safety and efficacy of the current dalteparin dosing recommendations in achieving therapeutic anti-Xa levels, when used for the treatment of thrombosis in neonates and infants. The objectives included: To assess the number of neonates/infants administered dalteparin for thrombotic events To evaluate how many neonates/infants achieved a therapeutic anti-Xa level (4 hour post-dose level of 0.5–1 unit/ml) To measure the duration between starting dalteparin and achieving a therapeutic anti-Xa level.MethodsRetrospective electronic searches were conducted to identify neonates and ch

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McKinzie, Brian P., Rabia Nizamani, Samuel Jones, Booker King, and Felicia N. Williams. "Single-center Experience with Venous Thromboembolism Prophylaxis for Obese Burn Patients." Journal of Burn Care & Research 42, no. 3 (2021): 365–68. http://dx.doi.org/10.1093/jbcr/irab039.

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Abstract Burn injured patients are at high risk of thromboembolic complications. Morbid obesity further increases this risk. Our objective was to evaluate the efficacy of enoxaparin dosed 40 mg twice daily in achieving prophylactic plasma anti-Xa levels in obese burn patients. A retrospective chart review from November 2018 until September 2019 identified patients who were either ≥100 kg or had a body mass index ≥30 kg/m2 and initiated on enoxaparin 40 mg twice daily for venous thromboembolism prophylaxis. Patients were ≥18 yr of age and received ≥3 sequential doses of enoxaparin with appropri

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&NA;. "Anti-Xa levels stable during extended dalteparin therapy." Inpharma Weekly &NA;, no. 1498 (2005): 19. http://dx.doi.org/10.2165/00128413-200514980-00051.

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Lim, Wendy, James Douketis, Luqi Wang, et al. "Anti-Xa Levels and Renal Function: Analysis of the First 32 Patients in the Tinzaparin in Renal Insufficiency for Venous Thromboembolism Study." Blood 106, no. 11 (2005): 906. http://dx.doi.org/10.1182/blood.v106.11.906.906.

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Abstract Background: Low-molecular-weight heparin (LMWH) is renally eliminated; its use in patients with renal insufficiency may be associated with accumulation and an increased bleeding risk. Due to its higher molecular weight and greater negative charge, tinzaparin may be less dependent on renal elimination compared to other LMWHs. As a result, tinzaparin may be less prone to accumulate in patients with renal insufficiency. Purpose: To measure the anticoagulant effect of a 5-day course of therapeutic-dose tinzaparin used for the initial treatment of venous thromboembolism (VTE) in patients w

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Leung, Marianna, Sharon H. Ho, Donald P. Hamilton, et al. "Utility of Anti-Xa Monitoring in Children Receiving Enoxaparin for Therapeutic Anticoagulation." Journal of Pediatric Pharmacology and Therapeutics 10, no. 1 (2005): 43–50. http://dx.doi.org/10.5863/1551-6776-10.1.43.

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Although enoxaparin is used to treat thromboembolism in children, current treatment guidelines are largely extrapolated from adults. The objectives of this study were to determine: i) correlation between enoxaparin dose and anti-factor Xa (anti-Xa) level, ii) intra-patient variability, and iii) whether dose or anti-Xa level is a predictor of outcomes. A retrospective chart review was conducted on all hospitalized patients receiving enoxaparin in a tertiary care pediatric institution. Simple linear regression, coefficient of variation (CV), and Student's t-test were used to analyze the objectiv

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McDonald, Ellen, Craig Dale, Susan Pleasance, et al. "Anti-Xa Levels in Critically Ill Patients Receiving Dalteparin for Thromboprophylaxis." Blood 104, no. 11 (2004): 4075. http://dx.doi.org/10.1182/blood.v104.11.4075.4075.

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Abstract Rationale: Despite the efficacy and safety of low molecular weight heparin (LWMH) compared to unfractionated (UFH) in many patients, LMWH may bioaccumulate in patients with renal insufficiency which could cause an increased risk of bleeding. If LMWH thromboprophylaxis is safe in ICU patients with renal insufficiency, this could reduce the risk of DVT and HIT. Since the extent to which LMWH bioaccumulates in critically ill patients in prophylactic rather than therapeutic doses is unclear, our objective was to measure peak and trough anti-Xa levels during a multicenter randomized pilot

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Logston, Brittany B., Emily A. Rodman, Kimberly L. Dinh, Jennifer L. Placencia, Brady S. Moffett, and Danielle R. Rios. "Effect of Exogenous Antithrombin Administration on Anti-Xa Levels in Infants Treated With Enoxaparin." Journal of Pediatric Pharmacology and Therapeutics 23, no. 4 (2018): 315–19. http://dx.doi.org/10.5863/1551-6776-23.4.315.

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OBJECTIVES Determine the effect of exogenous antithrombin III administration on low molecular weight heparin anti-Xa levels in the context of enoxaparin dosing in infants. METHODS A retrospective chart review of infants receiving concomitant antithrombin III and enoxaparin. The primary objective of this study was to determine the median change in anti-Xa level with antithrombin III supplementation. Secondary objectives were to analyze the median change in antithrombin III levels after administration of exogenous antithrombin III, the dosing of antithrombin III, and the dose of enoxaparin throu

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Gordon, Sharon E., Travis S. Heath, Ali B. V. McMichael, Christoph P. Hornik, and Caroline P. Ozment. "Evaluation of Heparin Anti–Factor Xa Levels Following Antithrombin Supplementation in Pediatric Patients Supported With Extracorporeal Membrane Oxygenation." Journal of Pediatric Pharmacology and Therapeutics 25, no. 8 (2020): 717–22. http://dx.doi.org/10.5863/1551-6776-25.8.717.

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OBJECTIVE Thrombotic events are potential complications in patients receiving extracorporeal membrane oxygenation (ECMO) necessitating the use of systemic anticoagulation with heparin. Heparin works by potentiating the effects of antithrombin (AT), which may be deficient in critically ill patients and can be replaced. The clinical benefits and risks of AT replacement in children on ECMO remain incompletely understood. METHODS This single-center, retrospective study reviewed 28 neonatal and pediatric patients supported on ECMO at a tertiary care hospital between April 1, 2013, and October 31, 2

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Crary, Shelley E., Heidi Van Orden, and Janna M. Journeycake. "Experience with Intravenous Enoxaparin in Critically Ill Infants and Children." Blood 108, no. 11 (2006): 881. http://dx.doi.org/10.1182/blood.v108.11.881.881.

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Abstract The use of subcutaneous (SC) low molecular weight heparin (LMWH), such as enoxaparin, in pediatric patients for treatment or prevention of thromboembolism is now considered standard practice; however, SC administration is often difficult in special populations such as premature neonates, children with minimal subcutaneous tissue, and critically ill children with severe edema. Impaired SC absorption may lead to difficulty achieving adequate anticoagulation, as measured by anti-Xa levels 4 to 6 hr after the second or third dose. Intravenous (IV) administration of enoxaparin has, therefo

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Yi, George, Adam M. Deane, Melissa Ankravs, Lucy Sharrock, James Anstey, and Yasmine Ali Abdelhamid. "A fixed dose approach to thrombosis chemoprophylaxis may be inadequate in heavier critically ill patients." Critical Care and Resuscitation 23, no. 1 (2021): 94–102. http://dx.doi.org/10.51893/2021.1.oa9.

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Objectives: Overweight patients are at greater risk of venous thromboembolism. We aimed to describe prescribing patterns of thrombosis chemoprophylaxis in critically ill patients weighing ≥ 100 kg and quantify the effectiveness of these regimens using the surrogate biomarker of plasma anti-Xa level. Design, setting and patients: A prospective single-centre cohort study was conducted over a 6-month period. Patients weighing ≥ 100 kg who were prescribed enoxaparin for chemoprophylaxis and expected to remain in the intensive care unit for > 48 hours were eligible. Anti-Xa levels were measured

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Greene, Lindsey A., Connie Law, Mike Jung, Sara Walton, and Leslie J. Raffini. "Lack Of Anti-Xa Assay Standardization Results In Significant Dose Variation In Neonates and Children Receiving Enoxaparin." Blood 122, no. 21 (2013): 2379. http://dx.doi.org/10.1182/blood.v122.21.2379.2379.

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Abstract Introduction Due to favorable pharmacokinetic properties, enoxaparin is the most frequently used anticoagulant in children. Unlike adults, a developing hemostatic system provides rationale for therapeutic monitoring with an anti-Xa goal of 0.5-1 units/ml. However, accepted therapeutic ranges are not well correlated with clinical outcomes (i.e. thrombosis or hemorrhage) and there is no assay standardization. In 2011 the coagulation laboratory at the Children's Hospital of Philadelphia (CHOP) changed anti-Xa laboratory assays resulting in anti-Xa levels that were on average, 33% higher

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Triantos, Christos, Emmanuel Louvros, Maria Kalafateli, et al. "Endogenous Heparinoids Detected by anti-Xa Activity are Present in Blood during Acute Variceal Bleeding in Cirrhosis. A Prospective Study." Journal of Gastrointestinal and Liver Diseases 23, no. 2 (2014): 187–94. http://dx.doi.org/10.15403/jgld.2014.1121.232.cht1.

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Background & Aims: Endogenous heparinoids have been detected by thromboelastography and quantified by clotting based anti-Xa activity assays in patients with cirrhosis, but their presence in variceal bleeding has not been established yet.Methods: Clotting based anti-Xa activity was measured in A) 30 cirrhotics with variceal bleeding, B) 15 noncirrhotics with peptic ulcer bleeding, C) 10 cirrhotics without infection or bleeding, and D) 10 cirrhotics with hepatocellular carcinoma (HCC).Results: Anti-Xa activity was not detected in ulcer bleeders or in cirrhotics without infection or bleeding

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Flaujac, Claire, Xavier Delavenne, Sara Quenet, et al. "Assessment of apixaban plasma levels by laboratory tests: suitability of three anti-Xa assays." Thrombosis and Haemostasis 111, no. 02 (2014): 240–48. http://dx.doi.org/10.1160/th13-06-0470.

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SummaryWhile laboratory monitoring is not required in patients treated with apixaban, a direct factor-Xa inhibitor, assessment of its concentration is useful in some critical situations. However, few data are available on its effect on coagulation tests and on the suitability of anti-Xa assays for its quantification. It was the objective of this study to identify laboratory tests suitable for apixaban concentration assessment. Coagulation tests – PT and aPTT- and anti-Xa assays were performed in apixaban-spiked plasma samples. To evaluate the sensitivity of PT and aPTT to apixaban, we conducte

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Wiegele, Marion, Dieter Adelmann, Christoph Dibiasi, Andrè Pausch, Andreas Baierl, and Eva Schaden. "Monitoring of Enoxaparin during Hemodialysis Covered by Regional Citrate Anticoagulation in Acute Kidney Injury: A Prospective Cohort Study." Journal of Clinical Medicine 10, no. 19 (2021): 4491. http://dx.doi.org/10.3390/jcm10194491.

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Background: Current guidelines recommend the monitoring of anti-factor Xa (anti-Xa) levels to avoid an accumulation of low-molecular-weight heparins in patients with acute kidney injury, but there is no evidence on how to proceed with such monitoring during continuous renal replacement therapy. Against this background, we investigated the potential accumulation of enoxaparin administered subcutaneously for venous thromboembolism prophylaxis in critically ill patients during continuous renal replacement therapy covered by regional citrate anticoagulation. Methods: Anti-Xa levels were measured a

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Bonnar, John, Mark Smith, Philip Steer, Geoff Savidge, and Lucy Norris. "Low molecular weight heparin (tinzaparin) therapy for moderate risk thromboprophylaxis during pregnancy." Thrombosis and Haemostasis 92, no. 10 (2004): 791–96. http://dx.doi.org/10.1160/th03-10-0618.

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SummaryLow molecular weight heparin (LMWH) is used increasingly for prophylaxis and treatment of venous thromboembolism during pregnancy. However, the prophylactic dose for patients at moderate risk varies between centers, and the recommended LMWH dose for the non pregnant patient is frequently used in pregnant women. The aim of this study was to investigate the effects of pregnancy on the pharmacokinetics of anti-Xa levels during moderate risk thromboprophylaxis with the LMWH, tinzaparin. In 24 pregnant women, one of three doses of tinzaparin (50, 75 or 100 IU/kg) were given according to the

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Pautas, E., M. Février, C. Wipff, et al. "Elderly Patients Treated with Tinzaparin (Innohep®) Administered once Daily (175 Anti-Xa IU/kg): Anti-Xa and Anti-IIa Activities over 10 Days." Thrombosis and Haemostasis 84, no. 11 (2000): 800–804. http://dx.doi.org/10.1055/s-0037-1614119.

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SummarySince low molecular weight heparins (LMWH) are partly eliminated by renal excretion, their pharmacodynamic profile may be modified in very elderly patients with age-related renal impairment. The aim of this prospective study was to determine whether tinzaparin (Innohep®) 175 anti-Xa IU/kg administered subcutaneously once daily over 10 days does accumulate in hospital patients greater than 70 years of age. Plasma anti-Xa and anti-IIa amidolytic levels and APTT were determined prior to the first injection (day 0), and then, at peak level i.e. 5 h after the second injection (day 2) and sub

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Mitchell, Lesley G., Stefan Kuhle, Patricia M. Massicotte, and Patricia Vegh. "Increased Incidence of Major Bleeding in Children Receiving Unfractionated Heparin for Clinical Management: A Prospective Cohort Study." Blood 104, no. 11 (2004): 1772. http://dx.doi.org/10.1182/blood.v104.11.1772.1772.

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Abstract BACKGROUND: Unfractionated heparin (UFH) is one of the most frequently prescribed drugs in paediatric tertiary care centres and is used in a diverse group of disorders including cardiopulmonary bypass, extra corporeal membrane oxygenation, dialyses and maintenance of both venous and arterial catheter patency. Dosing of UFH in children is extrapolated from adults and is assessed by either a chromogenic Anti-Xa assay or a clot-based activated partial thromboplastin time (aPTT). The overall objective of the study was to assess safety of current standard of practice in the use of therapeu

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Abdulla, Aliya, Caitlin M. Williams, Trisha N. Branan, and Susan E. Smith. "Optimal Dosing of Enoxaparin in Critically Ill Patients with Venous Thromboembolism." INNOVATIONS in pharmacy 14, no. 1 (2023): 2. http://dx.doi.org/10.24926/iip.v14i1.5174.

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Background: Evidence suggests that goal anti-Xa levels are achieved in only 33% of critically ill patients receiving standard prophylactic enoxaparin dosing. There has been limited focus on the potential suboptimal anticoagulation effect on medical intensive care unit (MICU) patients receiving therapeutic enoxaparin dosing for venous thromboembolism (VTE). Methods: MICU patients receiving enoxaparin 1 mg/kg twice daily or 1.5 mg/kg daily for VTE treatment in a 350-bed community teaching hospital between 2013 and 2019 with at least one peak anti-Xa level measured were included. The primary outc

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McMahon, Brandon, Sarah Yentz, Oluwatoyosi A. Onwuemene, Brady L. Stein, and Elizabeth H. Cull. "Clinical Use Of Anti-Xa Monitoring In Malignancy-Associated Thrombosis." Blood 122, no. 21 (2013): 3648. http://dx.doi.org/10.1182/blood.v122.21.3648.3648.

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Abstract Introduction Low molecular weight heparin (LMWH) is currently the preferred anticoagulant for malignancy-associated venous thromboembolism (VTE) given improved outcomes compared to warfarin. However, recurrent thrombosis still occurs in up to 9% of patients despite use of this preferred agent. Data to guide clinical decisions-making in the setting of recurrent thrombosis despite use of LMWH is lacking. Unlike warfarin or unfractionated heparin (UFH), LMWH typically does not require monitoring to determine efficacy or safety. However, many providers will still check a LMWH anti-Xa leve

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Hellstern, Peter, Juergen Bach, Melanie Simon, and Werner Saggau. "Heparin Monitoring During Cardiopulmonary Bypass Surgery Using the One-Step Point-of-Care Whole Blood Anti-Factor-Xa Clotting Assay Heptest-POC-Hi." Journal of ExtraCorporeal Technology 39, no. 2 (2007): 81–86. http://dx.doi.org/10.1051/ject/200739081.

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The activated clotting time (ACT) generally used for monitoring heparinization during cardiopulmonary bypass (CPB) surgery does not specifically measure heparin anticoagulant activities. This may result in heparin over- or under-dose and subsequent severe adverse events. A new point-of-care whole blood clotting assay (Heptest POC-Hi [HPOCH]) for quantifying heparin anticoagulant activity specifically was compared with ACT and anti-factor Xa (anti-Xa) heparin plasma levels (Coatest heparin) in 125 patients undergoing CPB surgery. The analytical reliability of the HPOCH and the influence of prea

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Yentz, Sarah, Oluwatoyosi A. Onwuemene, Brady L. Stein, Elizabeth H. Cull, and Brandon McMahon. "Clinical Use of Anti-Xa Monitoring in Malignancy-Associated Thrombosis." Thrombosis 2015 (October 12, 2015): 1–5. http://dx.doi.org/10.1155/2015/126975.

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Introduction. Low molecular weight heparin (LMWH) is preferred for malignancy-associated venous thromboembolism (VTE). Many providers monitor LMWH with anti-Xa levels, despite little validation on correspondence with patient outcome. Methods. This is a retrospective, single institution study of anti-Xa measurement in malignancy-associated thrombosis. Cases were identified using the Electronic Data Warehouse, and inclusion was confirmed by two independent reviewers. Malignancy type, thrombotic history, measurement rationale and accuracy, clinical context, and management changes were evaluated.

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Bhagirath, Vinai, John Eikelboom, Jack Hirsh, et al. "Apixaban-Calibrated Anti-FXa Activity in Relation to Outcome Events and Clinical Characteristics in Patients with Atrial Fibrillation: Results from the AVERROES Trial." TH Open 01, no. 02 (2017): e139-e145. http://dx.doi.org/10.1055/s-0037-1613679.

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Background In patients with nonvalvular atrial fibrillation (AF), apixaban is given in doses of 5 or 2.5 mg twice daily, according to clinical characteristics. The usual on-treatment range of apixaban drug levels, as determined by apixaban-calibrated anti-factor Xa (anti-Xa) activity, has previously been measured in small cohorts; however, the association between anti-Xa activity and clinical outcomes and the predictors of variability in anti-Xa activity have not been well studied in the AF population. Methods and Results Anti-Xa activity was measured before taking the morning dose, 3 months a

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Sabers, Andrew, Emilie Langenhan, Sean N. Avedissian, and Brandon Reynolds. "Evaluation of Anti-Xa Target Attainment with Prophylactic Enoxaparin Dosing Regimens for Venous Thromboembolism Prophylaxis in Morbidly Obese Patients." Pharmacy 12, no. 5 (2024): 133. http://dx.doi.org/10.3390/pharmacy12050133.

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Subcutaneous enoxaparin has been shown to reduce the risk of venous thromboembolism (VTE) among hospitalized patients. However, alternative enoxaparin dosing strategies may be necessary in morbid obesity. The objective of this study was to assess the rate of target anti-Xa attainment with three enoxaparin dosing regimens for venous thromboembolism (VTE) prophylaxis in morbidly obese patients. In this retrospective study, anti-Xa target attainment was assessed among adult patients with a body mass index (BMI) ≥ 40 kg/m2 receiving enoxaparin 40 mg twice daily (BID), 60 mg BID, or 0.5 mg/kg BID.

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Hart, Kayla, Benjamin Andrick, Stacey Grassi, Jesse Manikowski, and Jove Graham. "Cancer-Associated Venous Thromboembolism Treatment With Anti-Xa Versus Weight-Based Enoxaparin: A Retrospective Evaluation of Safety and Efficacy." Annals of Pharmacotherapy 55, no. 9 (2021): 1120–26. http://dx.doi.org/10.1177/1060028020988362.

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Background Venous thromboembolism (VTE) is a complication of cancer, for which low-molecular-weight heparin (LMWH) remains the preferred anticoagulant. Enoxaparin is traditionally dosed using weight. In certain populations, monitoring anti-Xa levels for therapeutic effect provides pharmacokinetic guidance for dose adjustments. There is a paucity of data regarding anti-Xa–directed enoxaparin dosing for treatment of VTE in patients with cancer. Objective This study aims to evaluate efficacy (recurrent VTE) and safety (major bleed) between enoxaparin anti-Xa–guided dose adjustments and weight-bas

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Elgersma, Brittany, and Sara Zochert. "Utilization of apixaban anti-Xa levels in transition from apixaban to warfarin in a patient with chronic renal dysfunction." American Journal of Health-System Pharmacy 79, no. 9 (2021): e104-e109. http://dx.doi.org/10.1093/ajhp/zxab469.

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Abstract Purpose The effect of apixaban on anti–factor Xa (anti-Xa) assays and international normalized ratio (INR) complicates transitions between anticoagulant agents. When switching from apixaban to warfarin, the recommendation is to begin both a parenteral anticoagulant and warfarin at the time of the next apixaban dose and to discontinue the parenteral agent when the INR is in an acceptable range. This proves challenging in renal dysfunction, as continued presence of apixaban contributes to both a prolonged effect on the INR and continued therapeutic levels of anticoagulation. Summary Thi

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