Could Anti-Xa Monitoring Prevent Clots in ICU Patients?

Low-molecular-weight heparin (LMWH) is the preferred agent for venous thromboembolism (VTE) prophylaxis in the ICU, but whether standard dosing delivers adequate anticoagulation in critically ill patients is uncertain. Researchers pooled 39 studies, involving ≈7000 ICU patients, in a systematic review and meta-analysis to examine how often patients reached target peak or trough anti-Xa levels, whether subprophylactic levels translate to elevated VTE risk, and patient factors associated with inadequate drug exposure. Most studies evaluated enoxaparin, most often using 40 mg once daily or 30 mg twice daily.