Article ; Online: Multicenter study evaluating target attainment of anti-Factor Xa levels using various enoxaparin prophylactic dosing practices in adult trauma patients.
2024 Volume 44, Issue 3, Page(s) 258–267
Abstract: Study objective: Enoxaparin is standard of care for venous thromboembolism (VTE) prophylaxis in adult trauma patients, but fixed-dose protocols are suboptimal. Dosing based on body mass index (BMI) or total body weight (TBW) improves target prophylactic ...
| Abstract | Study objective: Enoxaparin is standard of care for venous thromboembolism (VTE) prophylaxis in adult trauma patients, but fixed-dose protocols are suboptimal. Dosing based on body mass index (BMI) or total body weight (TBW) improves target prophylactic anti-Xa level attainment and reduces VTE rates. A novel strategy using estimated blood volume (EBV) may be more effective based on results of a single-center study. This study compared BMI-, TBW-, EBV-based, and hybrid enoxaparin dosing strategies at achieving target prophylactic anti-Factor Xa (anti-Xa) levels in trauma patients. Design: Multicenter, retrospective review. Data source: Electronic health records from participating institutions. Patients: Adult trauma patients who received enoxaparin twice daily for VTE prophylaxis and had at least one appropriately timed anti-Xa level (collected 3 to 6 hours after the previous dose after three consecutive doses) from January 2017 through December 2020. Patients were excluded if the hospital-specific dosing protocol was not followed or if they had thermal burns with > 20% body surface area involvement. Intervention: Dosing strategy used to determine initial prophylactic dose of enoxaparin. Measurements: The primary end point was percentage of patients with peak anti-Xa levels within the target prophylactic range (0.2-0.4 units/mL). Main results: Nine hospitals enrolled 742 unique patients. The most common dosing strategy was based on BMI (43.0%), followed by EBV (29.0%). Patients dosed using EBV had the highest percentage of target anti-Xa levels (72.1%). Multiple logistic regression demonstrated EBV-based dosing was significantly more likely to yield anti-Xa levels at or above target compared to BMI-based dosing (adjusted odds ratio (aOR) 3.59, 95% confidence interval (CI) 2.29-5.62, p < 0.001). EBV-based dosing was also more likely than hybrid dosing to yield an anti-Xa level at or above target (aOR 2.30, 95% CI 1.33-3.98, p = 0.003). Other pairwise comparisons between dosing strategy groups were nonsignificant. Conclusions: An EBV-based dosing strategy was associated with higher odds of achieving anti-Xa level within target range for enoxaparin VTE prophylaxis compared to BMI-based dosing and may be a preferred method for VTE prophylaxis in adult trauma patients. |
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| MeSH term(s) | Adult ; Humans ; Enoxaparin ; Anticoagulants ; Venous Thromboembolism/drug therapy ; Blood Coagulation Tests ; Burns |
| Chemical Substances | Enoxaparin ; Anticoagulants |
| Language | English |
| Publishing date | 2024-01-08 |
| Publishing country | United States |
| Document type | Multicenter Study ; Journal Article |
| ZDB-ID | 603158-4 |
| ISSN | 1875-9114 ; 0277-0008 |
| ISSN (online) | 1875-9114 |
| ISSN | 0277-0008 |
| DOI | 10.1002/phar.2904 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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