Heparin Anti-Xa
Note: this site is for informational purposes only. To view test results or book a test, use the NHS app in England or contact your GP.
The heparin anti-Xa test measures the activity of heparin in the blood using a blood sample taken from a vein in the arm. It is used to monitor and adjust heparin therapy, helping to ensure effective anticoagulation while reducing the risk of bleeding or clotting complications.
Why get tested?
To monitor low molecular weight heparin (LWMH) therapy and sometimes to monitor unfractionated heparin (UFH) therapy. LMWH and UFH are blood thinners. LMWHs are usually referred to by their specific drug names, such as dalteparin, enoxaparin or tinzaparin.
When to get tested?
When you are being treated with LMWH or UFH and your doctor wants to monitor the amount of heparin activity in your blood. This test is not performed routinely for everyone receiving LMWH therapy.
Sample required?
A blood sample taken from a vein, usually in your arm.
Test preparation needed?
No test preparation is needed, although the timing of the test relative to when the drug was administered is important.
What is being tested?
This test measures the effect of low molecular weight heparin (LMWH) or unfractionated heparin (UFH) in the blood by measuring anti-Xa activity.
Heparin is an anticoagulant, a drug that inhibits blood clotting. Heparin molecules vary in size and activity. UFH includes a broad range of sizes, while LMWH consists of a narrower range of smaller heparin molecules. There are several types of LMWH available and each one is slightly different. UFH is usually given intravenously (I.V.) and LMWH is usually given by a subcutaneous injection to people who have inappropriate blood clots (thrombi) and/or are at an increased risk of developing them.
Blood clotting is a normal response to blood vessel or tissue injury. It is a process that involves a sequential activation of proteins that regulate blood clot development. A variety of acute and chronic risk factors, including surgery, pregnancy and some oral contraceptives, serious illnesses and immobility are associated with inappropriate blood clot (thrombus) formation in veins – especially in the legs. These clots can obstruct blood flow and cause pain and swelling in the affected area. Pieces of the blood clot can break off and travel to the lungs – causing pulmonary embolism. Heparin can also inhibit blood clot formation in diseased arteries, which sometimes cause heart attacks or strokes, although it is not usually used to treat these two conditions.
Heparin interferes with the clotting process by enhancing the activity of a protein antithrombin. Antithrombin works to inactivate coagulation factors and thus heparin accelerates the inhibition of coagulation factors, particularly factors Xa and IIa (thrombin).
UFH, which affects both Xa and IIa, is more variable in its inhibitory activity, and must be closely monitored. This monitoring can be performed using a variety of tests including the APTT, ACT or less commonly by anti-Xa.
Complications of heparin use may include bleeding, and sometimes a serious complication called “HIT” (Heparin Induced Thrombocytopenia) causing a low platelet count and thrombosis at the same time. UFH is usually given in a hospital setting. High doses of UFH are given during surgery requiring cardiopulmonary bypass.
LMWH has more anti-Xa action than anti-IIa activity and the response to it is more predictable. It may be given in either an outpatient or hospital setting. Routine monitoring of LMWH is seldom required but when it is monitored, the anti-Xa test is used.
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm, most commonly taken three to four hours after your heparin injection to check the ‘peak’ level.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed other than correct timing.
Common questions
Anti-Xa tests are sometimes requested to monitor and adjust unfractionated heparin (UFH) concentrations in the blood, though the primary monitoring tool for UFH is currently the APTT (or ACT for cardiopulmonary bypass). Anti-Xa may be used to monitor some patients who have “heparin resistance” – do not respond as expected to UFH – or who have an underlying condition or interfering factor(s) that alter the APTT and ACT test result.
Low molecular weight heparin (LMWH) therapy is usually not monitored, but doctors may request anti-Xa tests in some cases. These include patients who are significantly underweight or overweight, those who have kidney disease and occasionally patients who are pregnant. LMWH is primarily cleared from the body by the kidneys. Any condition that decreases kidney function can potentially decrease LMWH clearance, increasing its concentration in the blood and increasing the potential for excessive bleeding.
The anti-Xa test is not routinely requested but may be performed whenever a doctor wants to evaluate UFH or LMWH concentrations in the blood.
When it is used as a LMWH monitoring tool, anti-Xa is primarily requested as a “peak” test. It is collected about 3–4 hours after a LMWH dose is given, when the concentration of LMWH in the blood is expected to be at its highest level. Random and “trough” anti-Xa tests may also be requested when a doctor suspects that a patient may not be clearing the LMWH at a normal rate. Trough tests are collected just prior to the next dose, when heparin concentrations are expected to be at their lowest.
Anti-Xa results must be evaluated in the context of the type of heparin that a person is receiving (UFH or LMWH and type of LMWH), the timing of the sample collection, and the condition that the person is being treated for. Results from different laboratories may not be interchangeable. Therapeutic reference ranges vary. Doctors should inform patients what the therapeutic range being used it,
In general, for UFH and LMWH, if concentrations are within an established therapeutic range and the patient is doing well clinically – not clotting, bleeding excessively, or experiencing other complications – then the dosage is considered appropriate. If the anti-Xa concentration is high, then the patient may be getting an excessive dose and/or not be clearing the drug at an expected rate and may be at an increased risk for excessive bleeding.
If the anti-Xa concentration is below the therapeutic range, then the dosage of heparin may need to be increased. When a person is not taking heparin, anti-Xa concentrations should be zero or undetectable.
Because of differences in the methods used for measuring anti-Xa and in the test results generated by various laboratories, samples for repeat anti-Xa testing should ideally be sent to the same laboratory.
UFH therapy is usually used for short periods of time to help treat and prevent inappropriate clotting. LMWH can be used for short or long periods. When long-term anticoagulation is required, other oral anticoagulants are commonly used unless LMWH is considered the best option (eg. in pregnancy or sometimes if there is a diagnosis of cancer).
Yes, this is information that will be important for doctors and other medical professionals to know when evaluating you for or determining treatment options for other conditions.