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

Abstract

In this study, subprophylactic anti-Xa trough levels were common in trauma patients. Enoxaparin dosage adjustment may lead to a reduced rate of VTE without an increased risk of bleeding.

Venous thromboembolic events in critically ill traumatic brain injury patients

“…Indeed studies have suggested that weight-adjusted dosing of PP is important in order to achieve therapeutic levels of antifactor Xa [27]. Dosing of PP guided by anti-Xa measurements has been shown to reduce the incidence of DVT without increasing bleeding rates [28].…”

The ATLANTIC study: Anti-Xa level assessment in trauma intensive care

“…Currently, it is not standard practice in ANZ to measure anti-Xa activity in patients receiving prophylactic LMWH. However, existing data suggest dose adjustment based on peak anti-Xa levels, may reduce the incidence of deep vein thrombosis (DVT) [12][13][14][15][16] .…”

“…Moreover, higher empirical dosing (e.g. 30 mg SC enoxaparin BD) may still provide inadequate chemoprophylaxis in many patients, as evidenced by low anti-Xa activity and the development of VTE [12][13][14][15]17,18] .…”

Adequacy of Fixed-Dose Heparin Infusions for Venous Thromboembolism Prevention after Microsurgical Procedures

“…13 Inadequate aFXa levels in surgical patients who receive enoxaparin prophylaxis have similarly been associated with symptomatic VTE in plastic surgery and trauma surgery patients and with all-cause VTE in the trauma and orthopaedic populations. [20][21][22][23] The heparin doses required to achieve goal prophylactic aFXa levels (8.9-18 units/kg/h) were similar to the starting infusion rate for the acute coronary syndrome protocol at our institution (12 units/kg/h). This may be due to the hypermetabolic nature of patients in the postoperative period.…”