Alternative dosing of prophylactic enoxaparin in the trauma patient: is more the answer?

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

“…Prophylactic enoxaparin monitoring may be based on anti-Xa peak or trough levels. A retrospective review by Kopelman et al 21 compared trauma patients receiving enoxaparin sodium at a dosage of 30 mg twice daily with those receiving a dosage of 40 mg twice daily. They monitored peak anti-Xa levels and found that although the group who received the higher dosage had improved peak levels, this did not translate to a statistically significant decrease in VTEs.…”

Supratherapeutic anti-factor Xa levels in patients receiving prophylactic doses of enoxaparin: A case series

“…Real time monitoring of enoxaparin effectiveness using aFXa level is increasingly common among surgical patients [3] , [4] , [5] , [6] . This manuscript provides several important learning points for surgeons who plan to monitor aFXa levels.…”

“…Anti-Factor Xa (aFXa) level is a surrogate marker for enoxaparin effectiveness and safety. aFXa monitoring and individualized enoxaparin dosing is increasingly common for surgical patients who receive enoxaparin prophylaxis [3] , [4] , [5] , [6] .…”

“…aFXa levels ≥0.5 IU/mL are considered to represent therapeutic anticoagulation [9] . Patients with out of range peak aFXa levels receive real time dose adjustment to optimize enoxaparin effectiveness and safety [3] , [4] , [6] .…”

Review of current evidence available for guiding optimal Enoxaparin prophylactic dosing strategies in obese patients—Actual Weight-based vs Fixed

“…based dosing(8,10, 14). The former group express an opinion that the dose, regardless of the actual patient weight, should be limited to or capped 40mg daily.…”