Objective The aim of this study was to evaluate the effectiveness of a body mass index (BMI)‐based enoxaparin prophylaxis dosing protocol at achieving target anti‐factor Xa (anti‐Xa) concentrations in the trauma population. Methods This retrospective chart review evaluated anti‐Xa concentrations in adult trauma patients who received prophylactic enoxaparin over a three‐month period. The primary outcome was the percentage of patients that achieved target anti‐Xa concentrations after ≥3 doses of enoxaparin. Secondary outcomes included correlations of anti‐Xa concentrations with enoxaparin dose per BMI, total body weight (TBW), and estimated blood volume (EBV). The prevalence of clinically relevant bleeding and venous thromboembolism was also recorded. Multivariable logistic regression was used to identify associated variables for target anti‐Xa concentration attainment. Results Ninety‐nine consecutive patients were included in the study. Included patients were predominately male (69.7%) and Black (50.5%) with a mean age of 44.1 years. Target anti‐Xa concentrations were achieved in 62.6% of patients. Anti‐Xa concentrations were moderately correlated with enoxaparin dose per EBV (ρ = 0.57), followed by dose per TBW (ρ = 0.46), and dose per BMI (ρ = 0.20). Multivariable logistic regression demonstrated that categorization of enoxaparin dose per EBV and per TBW were the only statistically significant predictors of reaching target anti‐Xa concentrations (p = <0.001). Conclusions In adult trauma patients, the rate of achieving target anti‐Xa concentrations remains suboptimal and provides room for further improvement. Enoxaparin dose per EBV was more closely correlated with anti‐Xa concentrations when compared to TBW and BMI. Dosing per EBV and TBW was the only variables associated with reaching target anti‐Xa concentrations within the study. Further investigation is warranted to elucidate optimal EBV‐ and TBW‐based dosing regimens.

BK polyomavirus-associated nephropathy (BKPyVAN) is a challenging cause of renal allograft failure with limited treatment options. Screening of BK virus (BKPyV) DNA by serum polymerase chain reaction (PCR), followed by early intervention has been established as an important tool for the prevention of BKPyVAN in renal transplant recipients. 1 The mainstay of management is reduction of immunosuppression and resultant immune reconstitution and subsequent clearance. 2 However, in some cases, patients may have persistent BKPyV presence in serum (BKPyV-DNAemia), despite an aggressive reduction in immunosuppressive burden. In this scenario, investigation of an alternate viral source is warranted. Screening and detection of BKPyV in the urine for monitoring and prevention of BKPyVAN is not the current preferred guideline endorsed strategy. 3 However in patients with persistence of BKPyV-DNAemia, assessing BK viruria may help identify a uroepithelial source. Based on our experience with the following case, we recommend checking urine BK viral loads with follow-up urologic evaluation via cystoscopy to rule out malignancy as a cause of persistent BK DNAemia.

Introduction: Pharmacotherapy-related prevention of cardiac allograft vasculopathy, optimal immunosuppression regimens, and metabolic management are essential for promotion of graft survival in heart transplant recipients.Methods: Following the addition of an ambulatory clinical pharmacist to the heart transplant team at an academic medical center in January 2018, we sought to assess the impact of pharmacist integration on pharmacotherapy-related clinical outcomes including goal blood pressure, diabetes control, appropriate statin and aspirin utilization, tacrolimus variability, and patient and graft outcomes at 1 year postheart transplant via a retrospective pre-post analysis.Results: Fifty-nine heart transplant recipients were included. At 1 year, the pharmacist cohort had a higher percentage of heart transplant recipients at goal blood pressure (93.1 vs 71.4%, P = .03), on a statin (96.7 vs 67.9%, P = .004), and with fewer 1 year hospital readmissions (55 vs 28, P = .03); no significant differences in HbA1c, aspirin use, tacrolimus level variability, or patient and graft survival were observed.Discussion: This analysis suggests that the integration of a pharmacist into the routine ambulatory care of heart transplant recipients is associated with improvement in several pharmacotherapy-related clinical outcomes.

Intrapatient variability (IPV) of tacrolimus has become a marker for predicting transplant outcomes, though minimal data exists regarding strategies to improve tacrolimus IPV. Following the implementation of comprehensive outpatient clinical pharmacy services, the impact of a dedicated lung transplant pharmacist on 1-year tacrolimus variability and clinical outcomes in lung transplant recipients (LTRs) were investigated. A retrospective study of two LTR cohorts was conducted at a singlecenter institution. Cohort 1 included LTRs from January 1, 2015 to December 31, 2017 with tacrolimus dose adjustments made by physicians or nurse practitioners, and were seen by a pharmacist on an ad hoc basis. Cohort 2 included LTRs from January 1, 2018 to December 31, 2019 with tacrolimus adjustments made solely by a pharmacist who saw them at each routine visit with the multidisciplinary team for the first year post-transplant. The primary outcome assessed tacrolimus variability by the coefficient of variation 12 months post-transplant. Secondary outcomes assessed post-transplant hospital readmissions, acute cellular rejection (ACR), donor-specific antibodies (DSA), and mortality at 12 months post-transplant. No protocol changes occurred during the study period. Chi-squared and t-tests analyses were utilized. Sixty-three LTRs were included, 39 patients in Cohort 1 and 24 inCohort 2 with no significant differences between cohorts. At 1-year post-transplant, Cohort 2 had lower median tacrolimus variability (35.7% vs. 30.3%, p = 0.02) and more patients had a tacrolimus variability <30% (20.5% vs. 45.8%, p = 0.03). There were no differences in readmission rates, ACR, DSA, or mortality 12 months posttransplant. Based on this single-center limited cohort study, the integration of a dedicated ambulatory transplant pharmacist improved tacrolimus variability 1 year following lung transplant. Further studies are needed to assess long-term morbidity and mortality rates.

No abstract