Anti-xa guided enoxaparin thromboprophylaxis is associated with less thromboembolism than fixed dose dalteparin in trauma patients admitted to intensive care.

Venous Thromboembolism (VTE) is a common, preventable complication in trauma. Low-molecular-weight heparin (LMWH) is recommended for VTE prophylaxis (VTEp). We investigated whether switching from fixed-dose dalteparin to anti-Xa-guided enoxaparin prophylaxis reduces VTE without increasing the risk of bleeding among hospitalized trauma patients. This observational study compared injured patients admitted one year before (pre-P) and after (post-P) implementing a new VTEp protocol. The protocol was introduced as a performance improvement project (subcutaneous enoxaparin 30 mg twice daily), with dose calibration to peak plasma Anti-Xa level measured after the 3rd dose. The primary outcomes were the rate of VTE and bleeding. After protocol implementation (post-P), 305 patients were compared to 350 pre-protocol patients (pre-P). Anti-Xa levels were measured in 83% of post-P and none in the pre-P. 40% had low levels of anti-Xa, suggesting inadequate prophylaxis, and enoxaparin doses were accordingly increased. 51% attained the desired anti-Xa levels, 9% had higher levels, and LMWH doses were subsequently reduced. VTE incidence after protocol implementation decreased from 4 to 1.3% (OR 0.31; 95% CI 0.1-0.9, P = 0.03) without increasing the bleeding rate. The time intervals between two consecutive PE events were significantly longer after protocol implementation. Among TBI patients, the rate of VTE was lower. However, it did not reach statistical significance. 75% of patients with VTE had low anti-Xa levels, while 20% of those with bleeding had high anti-Xa levels. Among adult patients in the trauma ICU, compared to a fixed dose dalteparin, enoxaparin prophylaxis with dose calibration according to peak anti-Xa levels was associated with lower VTE rates without increasing the risk of bleeding. About 40% of patients who received initial enoxaparin doses of 30 mg twice daily had anti-Xa levels suggestive of inadequate prophylaxis. Calibrating LMWH dosing may improve VTEp following traumatic injury.

Kloub A ，Alaieb A ，Kanbar A ，Abumusa S ，Alishaq F ，Hinawi Y ，Khan NA ，Asim M ，Abulkhair T ，El-Menyar A ，Al-Thani H ，Rizoli S ... -  《-》

Effect of a dalteparin prophylaxis protocol using anti-factor Xa concentrations on venous thromboembolism in high-risk trauma patients.

Droege ME ，Mueller EW ，Besl KM ，Lemmink JA ，Kramer EA ，Athota KP ，Droege CA ，Ernst NE ，Keegan SP ，Lutomski DM ，Hanseman DJ ，Robinson BR ... -  《-》

Association of Anti-Factor Xa-Guided Dosing of Enoxaparin With Venous Thromboembolism After Trauma.

Karcutskie CA ，Dharmaraja A ，Patel J ，Eidelson SA ，Padiadpu AB ，Martin AG ，Lama G ，Lineen EB ，Namias N ，Schulman CI ，Proctor KG ... -  《-》

A Weight- and Anti-Xa-Guided Enoxaparin Dosing Protocol for venous thromboembolism Prophylaxis in intensive care unit Trauma Patients.

Trauma patients are high risk for venous thromboembolism (VTE) and the optimal dosing strategy for prophylactic enoxaparin remains unknown. The purpose of this quality improvement project was to evaluate a weight-based and anti-Xa-guided enoxaparin dosing protocol in intensive care unit (ICU) trauma patients and to determine if the protocol led to reduced clinical VTE rates. Adult trauma patients admitted for ≥ 48 hours to our surgical or neurosurgical ICUs who received ≥ 3 consecutive weight-based enoxaparin doses were eligible for inclusion into this pre-post implementation cohort study. Enoxaparin 30 mg every 12 hours was used for weight 50 to 100 kg and body mass index (BMI) < 40 kg/m2 and enoxaparin 40 mg every 12 hours for weight ≥ 100 kg or BMI ≥ 40 kg/m2. PRE cohort patients did not routinely receive anti-Xa level monitoring, while in the POST cohort, dosing was subsequently titrated to peak anti-Xa levels of 0.2 to 0.4 IU/mL. A total of 110 and 113 patients were included in the PRE and POST cohorts, respectively. Clinical VTE rates were similar between groups. In the POST cohort, 75% of patients achieved goal anti-Xa levels without dose titrations, while 12% of higher weight patients and 9.1% of lower weight patients required adjustment. When comparing weight quartiles, patients > 100 kg were more likely to have sub-prophylactic anti-Xa levels than those ≤ 69 kg. Our enoxaparin dosing protocol was safe and frequently achieved initial anti-Xa levels within goal, indicating that weight-based dosing alone may be sufficient. However, patients > 100 kg may benefit from anti-Xa monitoring as they are highest risk for sub-prophylactic levels despite higher initial enoxaparin dosing.

Bigos R ，Solomon E ，Dorfman JD ，Ha M ... -  《-》

Association Between Enoxaparin Dosage Adjusted by Anti-Factor Xa Trough Level and Clinically Evident Venous Thromboembolism After Trauma.

Ko A ，Harada MY ，Barmparas G ，Chung K ，Mason R ，Yim DA ，Dhillon N ，Margulies DR ，Gewertz BL ，Ley EJ ... -  《-》