Faculty Collaboration Database

Multicenter study evaluating target attainment of anti-Factor Xa levels using various enoxaparin prophylactic dosing practices in adult trauma patients. Pharmacotherapy 2024 Mar;44(3):258-267

Date

12/27/2023

Pubmed ID

38148134

DOI

10.1002/phar.2904

Scopus ID

2-s2.0-85181719372 (requires institutional sign-in at Scopus site)

Abstract

STUDY OBJECTIVE: Enoxaparin is standard of care for venous thromboembolism (VTE) prophylaxis in adult trauma patients, but fixed-dose protocols are suboptimal. Dosing based on body mass index (BMI) or total body weight (TBW) improves target prophylactic anti-Xa level attainment and reduces VTE rates. A novel strategy using estimated blood volume (EBV) may be more effective based on results of a single-center study. This study compared BMI-, TBW-, EBV-based, and hybrid enoxaparin dosing strategies at achieving target prophylactic anti-Factor Xa (anti-Xa) levels in trauma patients.

DESIGN: Multicenter, retrospective review.

DATA SOURCE: Electronic health records from participating institutions.

PATIENTS: Adult trauma patients who received enoxaparin twice daily for VTE prophylaxis and had at least one appropriately timed anti-Xa level (collected 3 to 6 hours after the previous dose after three consecutive doses) from January 2017 through December 2020. Patients were excluded if the hospital-specific dosing protocol was not followed or if they had thermal burns with > 20% body surface area involvement.

INTERVENTION: Dosing strategy used to determine initial prophylactic dose of enoxaparin.

MEASUREMENTS: The primary end point was percentage of patients with peak anti-Xa levels within the target prophylactic range (0.2-0.4 units/mL).

MAIN RESULTS: Nine hospitals enrolled 742 unique patients. The most common dosing strategy was based on BMI (43.0%), followed by EBV (29.0%). Patients dosed using EBV had the highest percentage of target anti-Xa levels (72.1%). Multiple logistic regression demonstrated EBV-based dosing was significantly more likely to yield anti-Xa levels at or above target compared to BMI-based dosing (adjusted odds ratio (aOR) 3.59, 95% confidence interval (CI) 2.29-5.62, p < 0.001). EBV-based dosing was also more likely than hybrid dosing to yield an anti-Xa level at or above target (aOR 2.30, 95% CI 1.33-3.98, p = 0.003). Other pairwise comparisons between dosing strategy groups were nonsignificant.

CONCLUSIONS: An EBV-based dosing strategy was associated with higher odds of achieving anti-Xa level within target range for enoxaparin VTE prophylaxis compared to BMI-based dosing and may be a preferred method for VTE prophylaxis in adult trauma patients.

Author List

Chanas T, Gibson G, Langenstroer E, Herrmann DJ, Carver TW, Alexander K, Chui SHJ, Rein L, Ha M, Maynard KM, Bamberg K, O'Keefe M, O'Brien M, Gonzalez MC, Hobbs B, Pajoumand M, Peppard WJ

Authors

Thomas W. Carver MD Associate Professor in the Surgery department at Medical College of Wisconsin
William J. Peppard PharmD Trauma/Surgical Critical Care Pharmacist in the Pharmacy department at Froedtert Hospital

MESH terms used to index this publication - Major topics in bold

Adult
Anticoagulants
Blood Coagulation Tests
Burns
Enoxaparin
Humans
Venous Thromboembolism