Prophylactic Enoxaparin Adjusted by Anti-Factor Xa Peak Levels Compared with Recommended Thromboprophylaxis and Rates of Clinically Evident Venous Thromboembolism in Surgical Oncology Patients

Kramme, Katherine; Sarraf, Paya; Munene, Gitonga

doi:10.1016/j.jamcollsurg.2019.11.012

Cited by 19 publications

(23 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The outcomes of individual adjustment of LMWH dosing guided by anti-factor Xa monitoring are encouraging, though thus far it was only investigated in surgical or trauma patients [33,34]. The lower pooled prevalence of VTE in studies reported mixed anticoagulation approach (prophylactic and therapeutic) compared to studies reported prophylactic anticoagulation only (27% versus 38%) may have been possibly driven by on average higher rate of attaintment of target anti-factor Xa levels due to the use of therapeutic anticoagulation in some included patients.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis

Hasan

Radford

Kow

et al. 2020

J Thromb Thrombolysis

107

View full text Add to dashboard Cite

Many aspects of care such as management of hypercoagulable state in COVID-19 patients, especially those admitted to intensive care units is challenging in the rapidly evolving pandemic of novel coronavirus disease 2019 (COVID-19). We seek to systematically review the available evidence regarding the anticoagulation approach to prevent venous thromboembolism (VTE) among COVID-19 patients admitted to intensive care units. Electronic databases were searched for studies reporting venous thromboembolic events in patients admitted to the intensive care unit receiving any type of anticoagulation (prophylactic or therapeutic). The pooled prevalence (and 95% confidence interval [CI]) of VTE among patients receiving anticoagulant were calculated using the random-effects model. Subgroup pooled analyses were performed with studies reported prophylactic anticoagulation alone and with studies reported mixed prophylactic and therapeutic anticoagulation. We included twelve studies (8 Europe; 2 UK; 1 each from the US and China) in our systematic review and meta-analysis. All studies utilized LMWH or unfractionated heparin as their pharmacologic thromboprophylaxis, either prophylactic doses or therapeutic doses. Seven studies reported on the proportion of patients with the previous history of VTE (range 0–10%). The pooled prevalence of VTE among ICU patients receiving prophylactic or therapeutic anticoagulation across all studies was 31% (95% CI 20–43%). Subgroup pooled analysis limited to studies reported prophylactic anticoagulation alone and mixed (therapeutic and prophylactic anticoagulation) reported pooled prevalences of VTE of 38% (95% CI 10–70%) and 27% (95% CI 17–40%) respectively. With a high prevalence of thromboprophylaxis failure among COVID-19 patients admitted to intensive care units, individualised rather than protocolised VTE thromboprophylaxis would appear prudent at interim.

show abstract

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis

Hasan

Radford

Kow

et al. 2020

J Thromb Thrombolysis

107

View full text Add to dashboard Cite

show abstract

“… 47 Adjusting enoxaparin by anti-Xa peak or trough levels appears to lower the VTE rate without increasing bleeding complications in moderate to severely injured patients, trauma patients who require ICU admission, burn injuries, and surgical oncology patients. 47 – 49 , 75 Although some debate exists on the appropriate target for anti-Xa levels, consensus suggests targeting 0.2 to 0.4 IU/mL for peak levels or 0.1 to 0.2 IU/mL for trough levels. 47 – 50 , 55 , 75 , 76 Anti-Xa monitoring should also be considered for those patients who receive weight-based enoxaparin.…”

Section: Algorithmmentioning

confidence: 99%

“… 47 – 49 , 75 Although some debate exists on the appropriate target for anti-Xa levels, consensus suggests targeting 0.2 to 0.4 IU/mL for peak levels or 0.1 to 0.2 IU/mL for trough levels. 47 – 50 , 55 , 75 , 76 Anti-Xa monitoring should also be considered for those patients who receive weight-based enoxaparin. 50 , 53 , 76 …”

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

158

260

View full text Add to dashboard Cite

“…10 The VTE rate was decreased when enoxaparin dosing was adjusted compared to standard enoxaparin 30 mg, but the manner in which it was adjusted varied and suggests that weight-based dosing of enoxaparin at .5 mg/kg/dose might be successful. [4][5][6][7]11,12 Comparisons among these studies are challenging as some utilized anti-Xa peak levels as opposed to trough, and additionally some studies only included ICU patients. 11 Rather than determining the adequate enoxaparin dose by anti-Xa level or VTE rate, we reviewed predictors of low-dose enoxaparin in trauma patients to demonstrate that only CrCl was associated with lower enoxaparin dose.…”

Section: Discussionmentioning

confidence: 99%

“…2 Higher dosing of enoxaparin by anti-factor Xa level may be associated with a decreased rate of VTE without increasing the bleeding risk. [3][4][5][6][7] As many patients require several days to reach the appropriate dose for VTE prophylaxis, starting selected patients at an initial enoxaparin dose of 40 mg twice daily may be preferable to 30 mg twice daily. In one study, 39.4% of patients failed to reach a goal prophylactic dose despite attempts to titrate the enoxaparin dose.…”

Section: Introductionmentioning

confidence: 99%

Which Trauma Patients Require Lower Enoxaparin Dosing for Venous Thromboembolism Prophylaxis?

Veatch

Hashim

Dhillon

et al. 2020

The American Surgeon™

View full text Add to dashboard Cite

Trauma patients have a high risk for venous thromboembolism (VTE) such that an increased enoxaparin dose is necessary to reduce related complications. Given that most trauma patients require an enoxaparin dose of at least 40 mg every 12 hours for VTE prophylaxis, we sought to identify which patients require enoxaparin 30 mg every 12 hours and hypothesized that both weight and low creatinine clearance (CrCl) would more likely determine enoxaparin dosing than age, body mass index (BMI), or body surface area (BSA). Single institution data were collected on trauma patients between August 2014 and February 2018 to compare trauma patients who required enoxaparin 30 mg to those who required ≥40 mg every 12 hours. Of the 245 patients included, 86 (35.1%) required enoxaparin at 30 mg to achieve the goal anti-factor Xa trough level. Factors associated with low dose enoxaparin were older age (59.6 vs. 46.2 years, P ≤ .01) and lower CrCl (81.5 mL/min vs. 93.7 mL/min, P ≤ .01). Weight, BSA, and BMI did not alter the dose of enoxaparin. A regression model determined that only CrCl predicted the need for low dose enoxaparin (adjusted odds ratio .982, 95% CI: .975-.990, P < .01). Although an initial dose of enoxaparin 40 mg is appropriate for most trauma patients, patients with low CrCl should receive 30 mg. Increased age and low weight were not associated with the need for a lower enoxaparin dose.

show abstract

Prophylactic Enoxaparin Adjusted by Anti-Factor Xa Peak Levels Compared with Recommended Thromboprophylaxis and Rates of Clinically Evident Venous Thromboembolism in Surgical Oncology Patients

Cited by 19 publications

References 28 publications

Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis

Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis

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

Which Trauma Patients Require Lower Enoxaparin Dosing for Venous Thromboembolism Prophylaxis?

Contact Info

Product

Resources

About