Relation of antifactor-Xa peak levels and venous thromboembolism after trauma

Karcutskie, Charles A.; Dharmaraja, Arjuna; Patel, Jaimin; Eidelson, Sarah A.; Martin, Arch G.; Lineen, Edward B.; Namias, Nicholas; Schulman, Carl I.; Proctor, Kenneth G.

doi:10.1097/ta.0000000000001663

Cited by 21 publications

(23 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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] .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Rakhra

Martin

Fitzgerald

et al. 2020

Injury

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

“…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] .…”

Section: Introductionmentioning

confidence: 99%

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

Rakhra

Martin

Fitzgerald

et al. 2020

Injury

View full text Add to dashboard Cite

“…For example, Karcutskie et al demonstrated no difference in VTE rates in patients undergoing dose escalation to achieve peak values of 0.2-0.4 IU/mL. 3 Costantini et al demonstrated that dose escalation improved anti-Xa peak levels, but no difference in VTE rate was seen in this small study. Recently, however, improved outcome was observed in postoperative cancer patients.…”

Section: Discussionmentioning

confidence: 57%

“…Much attention has been given to using anti-Xa levels to guide enoxaparin dosing, but these studies have largely concentrated on examination of peak anti-Xa levels and have shown poor correlation between the adequate peak level and VTE rates. 3,12 Effective reduction of VTE rates with this strategy has not been well demonstrated, and a definitive strategy is lacking. Alternatively, adequate anti-Xa trough levels are associated with protection from VTE in trauma patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Weight-Based Enoxaparin Achieves Adequate Anti-Xa Levels More Often in Trauma Patients: A Prospective Study

Stutsrim

Eady

Collum

et al. 2020

The American Surgeon™

View full text Add to dashboard Cite

Background Previous research demonstrates that twice-daily enoxaparin is inadequate for venous thromboembolic (VTE) prophylaxis in critically ill trauma patients prompting dose adjustment based on anti-Xa levels. Most studies evaluate peak anti-Xa levels; however, data suggest that trough levels are associated with decreased VTE. We evaluated trough anti-Xa levels in noncritically ill trauma patients receiving fixed or weight-based enoxaparin. Methods Peak and trough anti-Xa levels were prospectively collected from patients receiving at least 3 consecutive doses of enoxaparin (PRE). A performance improvement project prompted a change to weight-based dosing. Peak and trough levels were subsequently prospectively collected from the weight-based group (POST). Adequate peak was defined as ≥0.2 IU/mL and adequate trough as ≥0.1 IU/mL. PRE and POST groups were compared. Results 200 patients were evaluated (100 PRE, 100 POST). In the PRE group, only 34% of trough and 61% of peak anti-Xa levels were adequate compared with 82% and 97%, respectively, in the POST group ( P < .01). Median trough improved from 0.07 IU/mL to 0.2 IU/mL ( P < .01). Median peak improved from 0.22 IU/mL to 0.47 IU/mL ( P < .01). More patients achieved adequate peak and trough levels in the POST group (79% vs 31%, P < .01). 95% of patients with adequate troughs also had adequate peaks, whereas 75% with adequate peaks had adequate troughs. Discussion Traditional enoxaparin dosing in noncritically ill trauma patients results in suboptimal anti-Xa levels. Weight-based enoxaparin improves both trough and peak anti-Xa levels obviating dose adjustment. Furthermore, troughs better predict adequate anti-Xa levels.

show abstract

Association of Changes in Antithrombin Activity Over Time With Responsiveness to Enoxaparin Prophylaxis and Risk of Trauma-Related Venous Thromboembolism

et al. 2022

View full text Add to dashboard Cite

IMPORTANCE Venous thromboembolism (VTE) affects 2% to 20% of recovering trauma patients, despite aggressive prophylaxis with enoxaparin. Antithrombin is a primary circulating anticoagulant and crucial component of enoxaparin thromboprophylaxis. Approximately 20% of trauma patients present with antithrombin deficiency (antithrombin activity <80%).OBJECTIVE To examine time-dependent changes in antithrombin activity, responsiveness to enoxaparin, as measured by anti-factor Xa (anti-FXa) levels, and incidence of VTE after severe trauma and to assess the association of ex vivo antithrombin supplementation with patients' sensitivity to enoxaparin prophylaxis. DESIGN, SETTING, AND PARTICIPANTSThis single-center, prospective cohort study was performed at a level 1 trauma center between January 7, 2019, and February 28, 2020. Adult trauma patients admitted to the trauma service at high risk for VTE, based on injury pattern and severity, were screened and enrolled. Patients who were older than 70 years, were pregnant, had a known immunologic or coagulation disorder, or were receiving prehospital anticoagulants were excluded.EXPOSURES Blood samples were collected on emergency department arrival and daily for the first 8 days of hospitalization. MAIN OUTCOMES AND MEASURESPatients' antithrombin activity and anti-FXa levels were measured by a coagulation analyzer, and thrombin generation was measured by calibrated automated thrombography. Responsiveness to enoxaparin was assessed by measuring anti-FXa levels 4 to 6 hours after the first daily enoxaparin dose and compared between patients who developed VTE and who did not. In addition, the associations of ex vivo supplementation of antithrombin with plasma anti-FXa levels were assessed. RESULTSAmong 150 patients enrolled (median [IQR] age, 35 [27-53] years; 37 [24.7%] female and 113 [75.3%] male; 5 [3.3%] Asian, 32 [21.3%] Black, and 113 [75.3%] White; and 51 [34.0%] of Hispanic ethnicity), 28 (18.7%) developed VTE. Patients with VTE had significantly lower antithrombin activity on admission compared with patients without VTE (median [IQR], 91% [79%-104%] vs 100% [88%-112%]; P = .04), as well as lower antithrombin activity on hospital days 5 (median (IQR), 90% [83%-99%] vs 114% [99%-130%]; P = .011), 6 (median [IQR], 97% [81%-109%] vs 123% [104%-134%]; P = .003), 7 (median [IQR], 82% [74%-89%] vs 123% [110%-140%]; P < .001), and 8 (median [IQR], 99% [85%-100%] vs 123% [109%-146%]; P = .011). Anti-FXa levels were significantly lower in patients with VTE vs those without VTE at hospital day 4 (median [IQR], 0.10 [0.05-0.14] IU/mL vs 0.18 [0.13-0.23] IU/mL; P = .006), day 6 (median [IQR], 0.12 [0.08-0.14] IU/mL vs 0.22 [0.13-0.28] IU/mL; P = .02), and day 7 (median [IQR], 0.11 [0.08-0.12] IU/mL vs 0.21 [0.13, 0.28] IU/mL; P = .002). Multivariable analyses found that for every 10% decrease in antithrombin activity during the first 3 days, the risk of VTE increased 1.5-fold. CONCLUSIONS AND RELEVANCEThe results of this cohort study suggest that after severe trauma, antithrombin defi...

show abstract

Relation of antifactor-Xa peak levels and venous thromboembolism after trauma

Abstract: Therapeutic study, level IV.

Cited by 21 publications

References 32 publications

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

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

Weight-Based Enoxaparin Achieves Adequate Anti-Xa Levels More Often in Trauma Patients: A Prospective Study

Association of Changes in Antithrombin Activity Over Time With Responsiveness to Enoxaparin Prophylaxis and Risk of Trauma-Related Venous Thromboembolism

Contact Info

Product

Resources

About