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Table 3 Methods of identifying optimal anticoagulant dose in thrombophilic pregnant women and those with pregnancy loss

From: Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients

QuestionExpert opinionGuideline recommendations
What method do you use to identify optimal dose of anticoagulants in thrombophilic pregnant women and those with pregnancy loss, e.g., PK/PD modelling or other methods?• Anti-Xa monitoring
• Factor Xa activity in prophylaxis is not measured
• Routine monitoring of the dose is not recommended, the clinical picture of each patients is more important
• PK/PD data is not usually used
• The PK/PD profile is required
• LMWH dose adjusted to weight
• Fixed dose
• Full-dose enoxaparin for high-risk patients
• ACCP/CHEST [28]: Anti-Xa measuring is not advised. Intermediate-dose LMWH dose is recommended in pregnant women with a history of VTE, with thrombophilia or with a risk of pregnancy loss
• ASH [14]: Routine anti-Xa monitoring to guide dosing is not advised
• Italian Society of Thrombosis and Haemostasis [29]: Monitoring platelet count during prophylaxis with LMWH is advised. No evidence to suggest use of anti-Xa monitoring to adjust LMWH dose
• RCOG [13]: Titration of LMWH dose against the woman’s booking or early pregnancy weight is advised. Routine measurement of anti-Xa is not recommended except in women < 50 kg or > 90 kg
  1. ACCP/CHEST, American College of Chest Physicians; ASH, American Society of Hematology; LMWH, low-molecular-weight heparin; PK/PD, pharmacokinetic/pharmacodynamic; RCOG, Royal College of Obstetricians and Gynaecologists; VTE, venous thromboembolism