{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:55:27Z","timestamp":1791474927729,"version":"4.3.4"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"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. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite the increasing use of direct oral anticoagulants, low-molecular-weight heparin (LMWH) remains important in venous thromboembolism (VTE) care when oral therapy is unsuitable, temporarily unsafe, or difficult to manage, particularly during pregnancy, cancer-associated thrombosis, renal impairment, and peri-procedural care. Objective: To review how LMWH pharmacology informs practical decisions about dosing, anti-factor Xa monitoring, treatment interruption and restart, and switching between anticoagulants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a narrative review of contemporary guidelines, randomized trials, systematic reviews, pharmacokinetic\/pharmacodynamic studies, drug labels, and laboratory medicine evidence, focusing on literature published from 1 January 2015 to 18 December 2025, with selected earlier sources retained for foundational pharmacologic principles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LMWH can be used with standard fixed or weight-based dosing in many stable patients, but reassessment is needed when renal function, body weight, pregnancy physiology, cancer-related bleeding risk, critical illness, or procedural timing changes the relationship between dose and exposure. Anti-factor Xa testing should not be used routinely; it is most useful when sampling is standardized and the result can guide a specific action, such as dose adjustment, interval extension, treatment interruption, or switching to unfractionated heparin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LMWH remains useful when oral anticoagulants are difficult to use safely. Its clinical value depends on clear dose selection, renal-function reassessment, selective monitoring, planned interruption and restart, and timely switching when patient risk or treatment feasibility changes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1824218","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:37:29Z","timestamp":1780637849000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Revisiting low-molecular-weight heparin for venous thromboembolism: from pharmacology to precision dosing and implementation"],"prefix":"10.3389","volume":"17","author":[{"given":"Sha","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Adult Intensive Care Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Ni","sequence":"additional","affiliation":[{"name":"Department of Adult Intensive Care Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji","family":"He","sequence":"additional","affiliation":[{"name":"Department of Adult Intensive Care Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1056\/NEJMoa1915103","article-title":"Apixaban for the treatment of venous thromboembolism associated with cancer","volume":"382","author":"Agnelli","year":"2020","journal-title":"N. 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