The effect of anti‐Xa monitoring on the safety and efficacy of low‐molecular‐weight heparin anticoagulation therapy: A systematic review and meta‐analysis

• Published in: Journal of clinical pharmacy and therapeutics Vol. 45; no. 4; pp. 602 - 608
• Main Authors: Wu, Tingting, Xia, Xiaotong, Chen, Wenjun, Fu, Jinglan, Zhang, Jinhua
• Format: Journal Article
• Language: English
• Published: England Hindawi Limited 01.08.2020
• Subjects: Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; anti‐Xa monitoring; Blood Coagulation - drug effects; efficacy; Factor Xa - metabolism; Factor Xa Inhibitors - therapeutic use; Health risk assessment; Hemorrhage - chemically induced; Hemorrhage - metabolism; Heparin; Heparin, Low-Molecular-Weight - adverse effects; Heparin, Low-Molecular-Weight - therapeutic use; Humans; low‐molecular‐weight heparin; Meta-analysis; Odds Ratio; safety; Systematic review; Thromboembolism; Venous Thromboembolism - drug therapy; Venous Thromboembolism - metabolism; anti-Xa monitoring; meta-analysis; low-molecular-weight heparin; safety; efficacy
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/jcpt.13169

What is known and objective Low‐molecular‐weight heparin (LMWH) is widely used in the prevention and treatment of venous thromboembolism (VTE), and anti‐Xa assay is the gold standard for monitoring LMWH. However, it is still controversial whether monitoring is necessary for patients receiving LMWH therapy. Therefore, we conducted a meta‐analysis to explore the effect of anti‐Xa monitoring on the safety and efficacy of LMWH anticoagulant therapy. Methods PubMed, EMBASE, Web of Science and The Cochrane Library were searched on 27 May 2019 for eligible studies published in English. Odds ratio (OR) and 95% confidence intervals (CI) were estimated (Mantel‐Haenszel method) using Review Manager version 5.3 software. The systematic review and meta‐analysis was performed according to the recommendations of the Preferred Reporting Items of Systematic Reviews and Meta‐Analyses (PRISMA) statement. Results and discussion Six studies involving 1617 patients were eligible for our meta‐analysis, with 724 patients in the anti‐Xa monitoring group and 893 patients in the control group. There was no significant difference in the incidence of bleeding events between the two groups, while the anti‐Xa monitoring group had a lower incidence of venous thromboembolism events (OR 0.44, 95% CI 0.29‐0.68, P = .0002). Subgroup analysis showed that the incidence of venous thromboembolism events in the anti‐Xa monitoring group was lower than that in the control group when the trough level was monitored (OR 0.40, 95% CI 0.25‐0.63, P < .0001), while there was no significant difference between the two groups when the peak level was monitored. What is new and conclusion Patients receiving LMWH anticoagulant therapy to prevent VTE can benefit from anti‐Xa monitoring, for which the trough level may be the more appropriate time status to monitor. The results of this meta‐analysis showed that patients receiving low‐molecular‐weight heparin anticoagulant therapy to prevent venous thromboembolism can benefit from anti‐Xa monitoring, for which the trough level may be the more appropriate time status to monitor.