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The following is a summary of “A retrospective Cohort study on the effect of the LOw-molecular weighT heparin (LMWH) nadroparin dose on anti-XA levels in a mixed medical-surgical ICU population: CLOT-Xa,” published in the April 2025 issue of Journal of Critical Care by Berkel et al. 

Low-molecular-weight heparins (LMWHs) have been commonly used to prevent and treat venous thromboembolism (VTE) in patients with critical illness.  

Researchers conducted a retrospective study to assess the dose-response relationship between nadroparin dose and anti-Xa activity in patients admitted to ICU.  

They included patients with critical illness admitted to ICU who received a minimum of 3 subcutaneous injections of nadroparin. The dose-effect relationship between nadroparin dosage and anti-Xa levels was analyzed using a mixed-effects logistic regression model.  

The results showed that 327 patients admitted to ICU were included, with median anti-Xa levels ranging from <0.1 IU/mL after nadroparin 0–37 IU/kg/day to 0.6 IU/mL after nadroparin >85 IU/kg/day (P < 0.01). Of the 1,520 anti-Xa measurements, 859 (57%) were within the desired range. The optimal anti-Xa levels were observed at nadroparin doses of 38–85 IU/kg (73%). No differences in bleeding or VTE odds were found across different anti-Xa levels.  

Investigators concluded that a clear dose-response relationship existed between nadroparin dose and anti-Xa levels and that higher nadroparin doses resulted in more appropriate anti-Xa levels without altering VTE or major bleeding rates, indicating that LMWH therapy could be effectively and safely individualized through anti-Xa guided dosing. 

Source: sciencedirect.com/science/article/abs/pii/S0883944124004787