This narrative review examines how to manage patients with venous thromboembolism, including those facing pregnancy, cancer, renal impairment, or needing peri-procedural care. The authors looked at low-molecular-weight heparin, direct oral anticoagulants, unfractionated heparin, and strategies like dosing, monitoring, and switching treatments.
The review found that low-molecular-weight heparin remains a useful option when oral anticoagulants cannot be used safely. For many stable patients, standard fixed or weight-based dosing works well. However, clinicians must reassess treatment when factors like renal function, body weight, pregnancy, cancer bleeding risk, or critical illness change the relationship between dose and drug exposure.
Routine anti-factor Xa testing is not recommended. It is most useful only when sampling is standardized and results can guide specific actions. The main reason to be careful is that clinical value depends on clear dose selection, renal-function reassessment, selective monitoring, and timely switching when patient risk or treatment feasibility changes. This evidence comes from a review, not a clinical trial, so it summarizes existing knowledge rather than testing new hypotheses.