• Lisanne van Berkel, Marnix Kuindersma, Ingrid D van Iperen, Henk J Adriaansen, Janine J J Hulstein, and Peter E Spronk.
• Departments of Intensive Care Medicine, Gelre Hospitals, Albert Schweitzerlaan 31, 7334, DZ, Apeldoorn, the Netherlands. Electronic address: lisannevanberkel@gmail.com.
• J Crit Care. 2024 Dec 16; 86: 154991154991.

PurposeLow-molecular-weight heparins (LMWHs) are widely used for prevention and treatment of venous thromboembolism (VTE) in critically ill patients. The objective of this study was to assess the dose-response relationship between nadroparin dose and anti-Xa activity in ICU patients.Materials And MethodsCritically ill adult patients who were admitted to the ICU, and received at least three subcutaneous injections of nadroparin were included. The dose-effect relationship between nadroparin dose and anti-Xa level was analysed through a mixed-effects logistic regression model.ResultsIn total, 327 ICU patients were included. Median anti-Xa levels ranged from <0.1 IU/mL after nadroparin 0-37 IU/kg/day to 0.6 IU/mL after nadroparin >85 IU/kg/day (p < 0.01). Among all 1520 anti-Xa measurements, 859 (57 %) measurements were in the desired anti-Xa range. The best adequacy of anti-Xa levels was observed in nadroparin doses of 38-85 IU/kg (73 %). No differences in the odds of bleeding events or VTE between different anti-Xa levels were found.ConclusionsWe found a clear dose-response relationship between nadroparin dose and anti-Xa levels. Increasing nadroparin doses led to more adequate anti-Xa levels without a change in the occurrence of VTE or major bleeding events, suggesting that LMWH therapy can be successfully and safely personalized using anti-Xa guided dosing.Copyright © 2024 Elsevier Inc. All rights reserved.

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