Supraprophylactic Anti–Factor Xa Levels Are Associated with Major Bleeding in Neurosurgery Patients Receiving Prophylactic Enoxaparin

May, Casey C.; Cua, Santino; Smetana, Keaton S.; Powers, Ciarán J.

doi:10.1016/j.wneu.2021.10.087

Cited by 6 publications

(8 citation statements)

References 16 publications

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“…Conversely, the question of whether supra-prophylactic anti-Xa levels are associated with higher bleeding risk remains a topic of ongoing debate. [18][19][20] Our study was not primarily designed to assess bleeding risk in patients with supra-prophylactic anti-Xa levels. Hence, we cannot conclude whether this subset of the population had a higher bleeding risk, or whether achieving adequate peak aFXa levels through a reduced dose of prophylactic LMHW could increase safety and efficacy in underweight patients.…”

Section: Discussionmentioning

confidence: 99%

“…These studies may highlight the viability of employing weight‐based dosing strategies for underweight patients. Conversely, the question of whether supra‐prophylactic anti‐Xa levels are associated with higher bleeding risk remains a topic of ongoing debate 18–20 . Our study was not primarily designed to assess bleeding risk in patients with supra‐prophylactic anti‐Xa levels.…”

Section: Discussionmentioning

confidence: 99%

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Monitoring anti‐Xa levels in elderly medical patients undergoing thromboprophylaxis: A prospective cohort study

Papazachariou,

Papadakis,

Malikides

et al. 2024

Geriatrics Gerontology Int

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IntroductionGiven the rising incidence of venous thromboembolism (VTE) and insufficient thromboprophylaxis dosing evidence in certain patients, the precise monitoring of anti‐Xa (aFXa) levels is crucial. The aim of this study is to investigate the achievement of prophylactic aFXa levels in medical inpatients who were receiving parenteral anticoagulant and to evaluate the impact of various factors on aFXa levels.MethodsThis is a single‐center observational cohort study conducted on patients admitted to the Department of Internal Medicine at the University Hospital of Heraklion, Greece, from March to August 2023. These individuals received low‐molecular‐weight heparins thromboprophylaxis owing to an increased risk of VTE. Data regarding demographics, past medical history, and somatometric and laboratory findings were recorded. The established range for peak prophylactic aFXa levels was defined as 0.2–0.5 IU/mL.ResultsIn this study, we enrolled 150 individuals [91 (60.7%) women] with a mean age of 80.0 ± 14.1 years. Sixty‐two (41.4%) patients exhibited non‐prophylactic peak aFXa levels. Supratherapeutic levels were observed in all underweight patients and subtherapeutic levels in 12 of 13 obese patients in class II and III. A multivariate linear regression analysis revealed that body weight, cancer, and the Charlson Comorbidity Index (CCI) were independent factors influencing aFXa levels.ConclusionsOur study reveals a substantial portion of medical elderly inpatients on thromboprophylaxis with non‐prophylactic aFXa levels, with a notable prevalence among underweight and severely obese patients. Body weight, cancer, and CCI were identified as independent factors influencing aFXa levels, advocating for tailored thromboprophylaxis strategies. Further research is warranted to validate personalized dosing approaches and to enhance clinical decision‐making. Geriatr Gerontol Int 2024; ••: ••–••.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Monitoring anti‐Xa levels in elderly medical patients undergoing thromboprophylaxis: A prospective cohort study

Papazachariou,

Papadakis,

Malikides

et al. 2024

Geriatrics Gerontology Int

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“…13 Anti-Xa assays should be used to monitor anticoagulant therapy, as supra-prophylactic levels have been associated with major bleeding in neurosurgical patients. 18 The timing of chemoprophylaxis may also affect the risk of intracranial bleeding, which is the highest within 24 h after surgery. At least one-third of VTE are identified in the first week after surgery.…”

Section: Intracranial Surgerymentioning

confidence: 99%

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.

Mora,

Gaudet,

Bilotta

et al. 2024

European Journal of Anaesthesiology

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“…However, there is some concern that this approach may put certain patient populations at risk for suboptimal effectiveness and safety. Anti‐Xa monitoring has been suggested for adult patients who are pregnant, critically ill, renally impaired, obese, or have cancer to measure the effect of LMWH treatment dosing, assess for overexposure, and guide LMWH dosing 6–10 . It is unclear if these same populations may benefit from anti‐Xa monitoring in the setting of VTE prophylaxis using LMWH regimens.…”

Section: Introductionmentioning

confidence: 99%

“…or have cancer to measure the effect of LMWH treatment dosing, assess for overexposure, and guide LMWH dosing. [6][7][8][9][10] It is unclear if these same populations may benefit from anti-Xa monitoring in the setting of VTE prophylaxis using LMWH regimens. Ambiguity exists regarding a true "therapeutic range" for LMWH anti-Xa monitoring and how/if to make dose adjustments based on these levels.…”

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confidence: 99%

Clinical outcomes associated with anti‐Xa‐monitored enoxaparin for venous thromboembolism prophylaxis

Saunders,

Vazquez,

Hill

et al. 2023

Pharmacotherapy

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Study ObjectiveThe objective of the study was to assess clinical outcomes (composite of any venous thromboembolism [VTE], any bleeding, and mortality) associated with anti‐Xa monitoring in the 30 days following enoxaparin initiation for VTE prophylaxis.DesignRetrospective cohort study.SettingHospital within an academic healthcare system.PatientsPropensity score‐matched hospitalized adults receiving enoxaparin for VTE prophylaxis.InterventionLow‐molecular‐weight heparin anti‐Xa monitoring.Measurements and Main ResultsDuring the 13‐month study period, a total of 6611 patients received enoxaparin for VTE prophylaxis, 301 in the anti‐Xa monitored group and 6310 in the unmonitored group (4.6% received monitoring). The mean age was 52.9 years and 52% of patients were male. The mean body mass index was 31 kg/m2 and the mean creatinine clearance was 109 mL/min. Twenty percent of patients had active cancer. The most common indication for enoxaparin prophylaxis was hospitalization for medical illness (52%) followed by nonorthopedic surgery (37%). The adjusted odds ratio for the primary outcome comparing monitored to unmonitored patients was 1.26 (95% confidence interval, 0.75–2.11). None of the between‐group differences in the individual components of the composite outcome were statistically significant.ConclusionsThirty‐day clinical outcomes in patients receiving enoxaparin for VTE prophylaxis were not improved by anti‐Xa monitoring. Our results support current evidence‐based guideline recommendations against anti‐Xa monitoring for patients receiving enoxaparin for VTE prophylaxis.

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Supraprophylactic Anti–Factor Xa Levels Are Associated with Major Bleeding in Neurosurgery Patients Receiving Prophylactic Enoxaparin

Cited by 6 publications

References 16 publications

Monitoring anti‐Xa levels in elderly medical patients undergoing thromboprophylaxis: A prospective cohort study

Monitoring anti‐Xa levels in elderly medical patients undergoing thromboprophylaxis: A prospective cohort study

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.

Clinical outcomes associated with anti‐Xa‐monitored enoxaparin for venous thromboembolism prophylaxis

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