Increased Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in General Trauma Patients

Walker, Cheri; Sandmann, Elizabeth A; Horyna, Taylor J; Gales, Mark A

doi:10.1177/1060028016683970

Cited by 58 publications

(68 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Finally, our data suggests most trauma patients will require enoxaparin doses higher than the current standard of 30 mg BID for VTE prophylaxis. This is consistent with recent literature and some have suggested increased empiric dosing or an initial weight-based enoxaparin dose 1,14. Unfortunately, this evidence base is still limited and there are no consensus recommendations concerning enoxaparin dosing for VTE prophylaxis in trauma patients.…”

Section: Discussionsupporting

confidence: 88%

Pharmacist recommendations for prophylactic enoxaparin monitoring and dose adjustment in trauma patients admitted to a surgical intensive care unit

Scrimenti¹,

Seabury²,

Miller³

et al. 2019

Pharm Pract (Granada)

View full text Add to dashboard Cite

Background:There is limited information describing pharmacist participation in prophylactic enoxaparin monitoring in the surgical intensive care unit (SICU).Objective:Our study sought to: 1) characterize pharmacist recommendations for enoxaparin monitoring in trauma patients admitted to the SICU, 2) describe the frequency that medical providers accept pharmacist recommendations for enoxaparin monitoring in trauma patients admitted to the SICU, and 3) illustrate the frequency that trauma patients admitted to our SICU service achieve anti-factor Xa trough concentrations (AFXa-TRs) of 0.11 - 0.20 IU/mL following pharmacist recommendation to adjust prophylactic enoxaparin dosing.Methods:Adult patients who had an AFXa-TR drawn after at least three consecutive prophylactic enoxaparin doses between June 1, 2017 and March 1, 2018 were identified through chart review and included in this study. Patients were excluded based on the following criteria: 1) age less than 18 years, 2) anti-factor Xa (AFXa) level not representative of a trough concentration, 3) AFXa-TR not representative of steady state concentration, and 4) non-trauma based prophylactic enoxaparin dosing. This study was exempt from IRB review.Results:The final analysis consisted of 42 patients. A pharmacist provided at least one recommendation in 97.6% (41/42) of trauma patients with enoxaparin monitoring during their SICU stay. In total, a pharmacist made 170 recommendations, mean of 4.2 (SD 1.8) recommendations per patient. Recommendations were: 1) obtain an AFXa-TR, n=90; 2) adjust enoxaparin dose based on AFXa-TR, n=58; and 3) maintain enoxaparin dose based on AFXa-TR, n=22. Medical providers accepted 89.4% (152/170) of pharmacist recommendations for enoxaparin monitoring. Dose adjustments were made in 33 patients following pharmacist recommendation; of these, 27 had a repeat AFXa-TR following at least one dose adjustment. Target AFXa-TRs were achieved in 19/27 patients, indicating 70.4% had recommended AFXa concentrations.Conclusions:Pharmacists provided recommendations for prophylactic enoxaparin monitoring and dose adjustment in trauma patients admitted to the SICU. Medical providers regularly accepted pharmacist recommendations and trauma patients commonly achieved target AFXa-TR following pharmacist recommendation for dose adjustment. Further research is required to identify the optimal enoxaparin dose for VTE prophylaxis in trauma patients.

show abstract

Section: Discussionsupporting

confidence: 88%

Pharmacist recommendations for prophylactic enoxaparin monitoring and dose adjustment in trauma patients admitted to a surgical intensive care unit

Scrimenti¹,

Seabury²,

Miller³

et al. 2019

Pharm Pract (Granada)

View full text Add to dashboard Cite

show abstract

“…The initial enoxaparin dose for trauma patients with a normal creatine clearance may also be based on weight. Options include 0.5 mg/kg twice daily, 51 , 52 0.6 mg/kg twice daily, 53 or 30 mg for 50 to 60 kg patients, 40 mg for 61 to 99 kg patients, and 50 mg for patients greater than 100 kg. 54 Patients who are initiated on higher doses of enoxaparin based upon weight should be monitored by anti-Xa levels because of the fluctuations in creatinine clearance after trauma that might lead to changes in the enoxaparin dose.…”

Section: Algorithmmentioning

confidence: 99%

Updated guidelines to reduce venous thromboembolism in trauma patients: A Western Trauma Association critical decisions algorithm

Ley

Brown

Moore³

et al. 2020

J Trauma Acute Care Surg

156

260

View full text Add to dashboard Cite

“…This clinical pharmacist facilitated COVID-19 patients' ultrasound screening, diagnosis, and monitoring of prophylactic and full anticoagulation treatment. [18][19][20][21]47 This multidisciplinary team was adapted from previous programs that utilized a similar dynamic for management of trauma-related anticoagulation…”

Section: Discussionmentioning

confidence: 99%

“…In such models, the clinical pharmacist's duties include medication stewardship in addition to the screening, diagnosis, and monitoring of prophylactic and full anticoagulation treatment. [18][19][20][21] Since the start of the COVID-19 pandemic, experience from China, Europe and the United States has revealed that clinical pharmacists are essential for providing event-driven pharmaceutical care which goes beyond routine activities such as medication review, prescription support, and patient counselling. 13,14,[22][23][24][25] Here, the coordination of four-extremity screening ultrasound for all admitted COVID-19 patients was added to the workload of the clinical pharmacist.…”

Section: Introductionmentioning

confidence: 99%

Impact of a clinical pharmacist in ultrasound-guided venous thromboembolism screening in hospitalized COVID-19 patients: a pilot prospective study.

Gillespie

Khan

Stillson

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The recognition, prevention and treatment of venous thromboembolism (VTE) remains a major challenge in the face of the recent SARS-COV-2 pandemic which has been associated with significant cardiovascular, renal, respiratory and hematologic complications related to hypercoagulability. There has been little literature thus far on the utility of screening ultrasound and role of the clinical pharmacist in treating these patients.Methods: We present a prospective pilot program of thirty-one consecutive SARS-CoV-2 patients who were provided four extremity screening ultrasounds for VTE on admission. This was coordinated by a clinical pharmacist as part of a multidisciplinary approach. Quantitative and qualitative data were recorded with the goal of describing the utility of the clinical pharmacist in ultrasound screening. Data collected include: demographics, information on clinical symptoms or signs at presentation, and laboratory and radiologic results during the hospitalization from each individual electronic medical record.Results: Nine of the thirty-one patients presented with venous thrombosis. Of the nine patients, there were twenty-two total clotted vessels, all of which were asymptomatic. The clinical pharmacist, as the coordinator for a multidisciplinary COVID-19 associated coagulopathy management team, drafted a screening and treatment protocol for anticoagulation prophylaxis and therapy of VTE after ultrasound findings.Conclusion: VTE screening of hospitalized SARS-CoV-2 patients reveals a significant number of asymptomatic VTEs and justifies diagnostic, prophylactic, and treatment measures coordinated by a clinical pharmacist.

show abstract

Increased Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in General Trauma Patients

Abstract: Standard-dose enoxaparin prophylaxis may not be optimal for the general trauma patient population. Weight-based enoxaparin dosing (0.5 mg/kg/dose BID) is an option in trauma patients considered to be at a lower risk of bleeding complications.

Cited by 58 publications

References 53 publications

Pharmacist recommendations for prophylactic enoxaparin monitoring and dose adjustment in trauma patients admitted to a surgical intensive care unit

Pharmacist recommendations for prophylactic enoxaparin monitoring and dose adjustment in trauma patients admitted to a surgical intensive care unit

Updated guidelines to reduce venous thromboembolism in trauma patients: A Western Trauma Association critical decisions algorithm

Impact of a clinical pharmacist in ultrasound-guided venous thromboembolism screening in hospitalized COVID-19 patients: a pilot prospective study.

Contact Info

Product

Resources

About