{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T11:36:32Z","timestamp":1773920192026,"version":"3.50.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cohort study included postpartum VTE patients treated with nadroparin at Shanghai First Maternity and Infant Hospital (September 2021\u2013July 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\u20131.0\u202fIU\/mL following the 4th dose were classified as the therapeutic group. All participants were followed for 1\u202fyear. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u202f\u00b1\u202f0.08\u202fIU\/mL (day 0), reaching 0.59\u202f\u00b1\u202f0.19\u202fIU\/mL (day 5). Anti-Xa levels correlated positively with R (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f7.88,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and K (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f1.45,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.01), and negatively with Angle (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f\u221218.38,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). No significant differences were observed thrombus or adverse events between groups; but the therapeutic group demonstrated shorter hospitalization (7.54\u202f\u00b1\u202f1.72 vs. 9.04\u202f\u00b1\u202f3.14\u202fdays,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.044).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nadroparin shows a nonlinear dose\u2013response in postpartum VTE. Anti-Xa levels and TEG correlations may enhance individualized anticoagulation monitoring strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.chictr.org.cn\/bin\/project\/edit?pid=132010<\/jats:ext-link>\n                      , ChiCTR2100051002.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1786254","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T06:48:23Z","timestamp":1773902903000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Monitoring anti-Xa levels and thromboelastography in puerperal venous thromboembolism: a prospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Ruijing","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weimin","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yilu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meixiang","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhendong","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/AOG.0000000000002706","article-title":"ACOG practice bulletin no. 196: thromboembolism in pregnancy","volume":"132","year":"2018","journal-title":"Obstet Gynecol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1111\/bjh.13159","article-title":"The prevention of pregnancy-related venous thromboembolism","volume":"168","author":"Guimicheva","year":"2015","journal-title":"Br J Haematol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e55","DOI":"10.1097\/AOG.0000000000004477","article-title":"Anemia in pregnancy: ACOG practice bulletin, number 233","volume":"138","year":"2021","journal-title":"Obstet Gynecol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3317","DOI":"10.1182\/bloodadvances.2018024802","article-title":"American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy","volume":"2","author":"Bates","year":"2018","journal-title":"Blood Adv"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.ejim.2021.12.013","article-title":"Venous thromboembolism during pregnancy and postpartum period","volume":"97","author":"Bukhari","year":"2022","journal-title":"Eur J Intern Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1002\/uog.17360","article-title":"Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta-analysis","volume":"49","author":"de Haas","year":"2017","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref7","first-page":"18","article-title":"Maternity and neonatal clinical guideline: guidelines for venous thromboembolism prophylaxis in pregnancy and the puerperium","year":"2020","journal-title":"Interne"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1177\/1076029610371470","article-title":"A prospective trial showing the safety of adjusted-dose enoxaparin for thromboprophyl axis of pregnant women with mechanical prosthetic heart valves","volume":"17","author":"Saeed","year":"2011","journal-title":"Clin Appl Thromb Hemost"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1055\/s-0041-1726374","article-title":"Anti-Xa monitoring of low-molecular-weight heparin during pregnancy: a systematic review","volume":"47","author":"Kjaergaard","year":"2021","journal-title":"Semin Thromb Hemost"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.injury.2019.10.066","article-title":"The ATLANTIC study: anti-Xa level assessment in trauma intensive care","volume":"51","author":"Rakhra","year":"2020","journal-title":"Injury"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2420","DOI":"10.1111\/jth.15007","article-title":"\u201cSystematic review of viscoelastic testing (TEG\/ROTEM) in obstetrics and recommendation from the women\u2019s SSC of the ISTH\u201d: response to comment from kitchen et al","volume":"18","author":"Favaloro","year":"2020","journal-title":"J Thromb Haemost"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.ijoa.2016.10.001","article-title":"Thromboelastography (TEG(R)) demonstrates that tinzaparin 4500 international units has no detectable anticoagulant activity after caesarean section","volume":"29","author":"Griffiths","year":"2017","journal-title":"Int J Obstet Anesth"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e162069","DOI":"10.1001\/jamasurg.2016.2069","article-title":"Thrombelastography-based dosing of enoxaparin for thromboprophyl axis in trauma and surgical patients: a randomized clinical trial","volume":"151","author":"Connelly","year":"2016","journal-title":"JAMA Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1097\/OGX.0b013e3182605861","article-title":"Obstetric hemorrhage and coagulation: an update. Thromboelastography, thromboelastometry, and conventional coagulation tests in the diagnosis and prediction of postpartum hemorrhage","volume":"67","author":"de Lange","year":"2012","journal-title":"Obstet Gynecol Surv"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2162","DOI":"10.3760\/cma.j.cn112137-20250509-01141","article-title":"Chinese guidelines for the diagnosis, treatment, prophylaxis and management of pulmonary thromboembolism (2025 edition)","volume":"105","year":"2025","journal-title":"Chin Med J"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1111\/j.1365-2141.2011.08956.x","article-title":"Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study","volume":"156","author":"Sultan","year":"2012","journal-title":"Br J Haematol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1097\/OGX.0000000000000505","article-title":"The safety of low-molecular-weight heparin during and after pregnancy","volume":"72","author":"Lu","year":"2017","journal-title":"Obstet Gynecol Surv"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1159\/000467385","article-title":"Thrombogenesis in Thrombophilic pregnancy: evaluation of low-molecular-weight heparin prophylaxis","volume":"137","author":"Simeone","year":"2017","journal-title":"Acta Haematol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"538","DOI":"10.2298\/vsp0708538p","article-title":"Determination of factor Xa inhibition doses of low-molecular heparin, nadroparin and reviparin in urological patients","volume":"64","author":"Pavlovic","year":"2007","journal-title":"Vojnosanit Pregl"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e294","DOI":"10.1097\/PCC.0000000000000169","article-title":"Higher doses of low-molecular-weight heparin (enoxaparin) are needed to achieve target anti-Xa concentrations in critically ill children*","volume":"15","author":"Schloemer","year":"2014","journal-title":"Pediatr Crit Care Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/j.thromres.2012.03.007","article-title":"The risk of postpartum hemorrhage in women using high dose of low-molecular-weight heparins during pregnancy","volume":"130","author":"Knol","year":"2012","journal-title":"Thromb Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1001\/jamasurg.2016.1662","article-title":"Association between enoxaparin dosage adjusted by anti-factor Xa trough level and clinically evident venous thromboembolism after trauma","volume":"151","author":"Ko","year":"2016","journal-title":"JAMA Surg"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-020-02873-2","article-title":"A prospective cohort study comparing achieved anti-factor Xa peak levels in pregnant and non-pregnant patients receiving therapeutic-dose low-molecular-weight heparin","volume":"112","author":"Aleidan","year":"2020","journal-title":"Int J Hematol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1002\/jcph.2210","article-title":"Low early Antifactor Xa target achievement rate of low-molecular-weight heparin for treating venous thromboembolism in patients in intensive care","volume":"63","author":"Zhang","year":"2023","journal-title":"J Clin Pharmacol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1024\/0301-1526\/a000504","article-title":"Treatment of pregnancy-associated venous thromboembolism-position paper from the working Group in Women's health of the Society of Thrombosis and Haemostasis (GTH)","volume":"45","author":"Linnemann","year":"2016","journal-title":"Vasa"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1586\/erc.10.160","article-title":"Prevention of venous thromboembolism in obesity","volume":"8","author":"Freeman","year":"2010","journal-title":"Expert Rev Cardiovasc Ther"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1007\/s11239-021-02478-4","article-title":"Impact of antithrombin III and enoxaparin dosage adjustment on prophylactic anti-Xa concentrations in trauma patients at high risk for venous thromboembolism: a randomized pilot trial","volume":"52","author":"Droege","year":"2021","journal-title":"J Thromb Thrombolysis"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1160\/TH03-11-0694","article-title":"In vitro comparison of the effect of fondaparinux and enoxaparin on whole blood tissue factor-triggered thromboelastography profile","volume":"92","author":"Gerotziafas","year":"2004","journal-title":"Thromb Haemost"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e0116835","DOI":"10.1371\/journal.pone.0116835","article-title":"Monitoring low molecular weight heparins at therapeutic levels: dose-responses of, and correlations and differences between aPTT, anti-factor Xa and thrombin generation assays","volume":"10","author":"Thomas","year":"2015","journal-title":"PLoS One"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1055\/s-0040-1718760","article-title":"Extracellular histones inhibit fibrinolysis through noncovalent and covalent interactions with fibrin","volume":"121","author":"Locke","year":"2021","journal-title":"Thromb Haemost"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.1038\/s41467-019-09160-7","article-title":"Neutrophil activation and NETosis are the major drivers of thrombosis in heparin-induced thrombocytopenia","volume":"10","author":"Perdomo","year":"2019","journal-title":"Nat Commun"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1111\/jth.14882","article-title":"Systematic review of viscoelastic testing (TEG\/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH","volume":"18","author":"Amgalan","year":"2020","journal-title":"J Thromb Haemost"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"151477","DOI":"10.1016\/j.semnephrol.2023.151477","article-title":"Laboratory monitoring of heparin anticoagulation in hemodialysis: rationale and strategies","volume":"43","author":"Chiasakul","year":"2023","journal-title":"Semin Nephrol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1786254\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T06:48:24Z","timestamp":1773902904000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1786254\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,19]]},"references-count":33,"alternative-id":["10.3389\/fmed.2026.1786254"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1786254","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,19]]},"article-number":"1786254"}}