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Monitoring anti-Xa levels and thromboelastography in puerperal venous thromboembolism: a prospective cohort study

Ruijing Ma¹, Weimin Tao¹, Wei Luo¹

¹Department of Anesthesiology and Intensive Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.

Frontiers in Medicine

|April 6, 2026

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 (β = 7.88, p < 0.001) and K (β = 1.45, p = 0.01), and negatively with Angle (β = -18.38, p < 0.001). No significant differences were observed thrombus or adverse events between groups; but the therapeutic group demonstrated shorter hospitalization (7.54 ± 1.72 vs. 9.04 ± 3.14 days, p = 0.044).

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.

Keywords:

anti-Xa levels nadroparin puerperium thromboelastography venous thromboembolism

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