Inadequate prophylaxis in patients with trauma: anti-Xa-guided enoxaparin dosing management in critically ill patients with trauma
Methods This prospective observational study included patients with trauma admitted to the trauma intensive care unit (ICU) from January 2021 to September 2022. Enoxaparin dosing was adjusted based on anti-Xa levels as standard of care via a performance improvement initiative. The primary outcome wa...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-04-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/9/1/e001287.full |
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| author | Niels D Martin Grace Martin Niziolek Lauren Mangan Cassidi Weaver Vanessa Prendergast Raymond Lamore Megan Zielke |
| author_facet | Niels D Martin Grace Martin Niziolek Lauren Mangan Cassidi Weaver Vanessa Prendergast Raymond Lamore Megan Zielke |
| author_sort | Niels D Martin |
| collection | DOAJ |
| description | Methods This prospective observational study included patients with trauma admitted to the trauma intensive care unit (ICU) from January 2021 to September 2022. Enoxaparin dosing was adjusted based on anti-Xa levels as standard of care via a performance improvement initiative. The primary outcome was the proportion of subtarget anti-Xa levels (<0.2 IU/mL) on 30 mg two times per day dosing of enoxaparin. Secondary outcomes included the dosing modifications to attain goal anti-Xa levels, VTE and bleeding events, and hospital and ICU lengths of stay.Results A total of 282 consecutive patients were included. Baseline demographics revealed a median age of 36 (26–55) years, and 44.7% with penetrating injuries. Of these, 119 (42.7%) achieved a target anti-Xa level on a starting dose of 30 mg two times per day. Dose modifications for subtarget anti-Xa levels were required in 163 patients (57.8%). Of those, 120 underwent at least one dose modification, which resulted in 78 patients (47.8%) who achieved a target level prior to hospital discharge on a higher dose of enoxaparin. Overall, only 69.1% of patients achieved goal anti-Xa level prior to hospital discharge. VTE occurred in 25 patients (8.8%) and major bleeding in 3 (1.1%) patients.Conclusion A majority of critically injured patients do not meet target anti-Xa levels with 30 mg two times per day enoxaparin dosing. This study highlights the need for anti-Xa-based dose modification and efficacy of a pharmacy-driven protocol. Further optimization is warranted to mitigate VTE events.Level of evidence Therapeutic/care management, level III |
| format | Article |
| id | doaj-art-e90e1c8024f646389b8fcd69a7fcfbc8 |
| institution | DOAJ |
| issn | 2397-5776 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-e90e1c8024f646389b8fcd69a7fcfbc82025-08-20T03:11:33ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762024-04-019110.1136/tsaco-2023-001287Inadequate prophylaxis in patients with trauma: anti-Xa-guided enoxaparin dosing management in critically ill patients with traumaNiels D Martin0Grace Martin Niziolek1Lauren Mangan2Cassidi Weaver3Vanessa Prendergast4Raymond Lamore5Megan Zielke6Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USASurgery, Washington University in St Louis, St Louis, Missouri, USAUniversity of Pennsylvania, Philadelphia, Pennsylvania, USAUniversity of Pennsylvania, Philadelphia, Pennsylvania, USAUniversity of Pennsylvania, Philadelphia, Pennsylvania, USAUniversity of Pennsylvania, Philadelphia, Pennsylvania, USAUniversity of Pennsylvania, Philadelphia, Pennsylvania, USAMethods This prospective observational study included patients with trauma admitted to the trauma intensive care unit (ICU) from January 2021 to September 2022. Enoxaparin dosing was adjusted based on anti-Xa levels as standard of care via a performance improvement initiative. The primary outcome was the proportion of subtarget anti-Xa levels (<0.2 IU/mL) on 30 mg two times per day dosing of enoxaparin. Secondary outcomes included the dosing modifications to attain goal anti-Xa levels, VTE and bleeding events, and hospital and ICU lengths of stay.Results A total of 282 consecutive patients were included. Baseline demographics revealed a median age of 36 (26–55) years, and 44.7% with penetrating injuries. Of these, 119 (42.7%) achieved a target anti-Xa level on a starting dose of 30 mg two times per day. Dose modifications for subtarget anti-Xa levels were required in 163 patients (57.8%). Of those, 120 underwent at least one dose modification, which resulted in 78 patients (47.8%) who achieved a target level prior to hospital discharge on a higher dose of enoxaparin. Overall, only 69.1% of patients achieved goal anti-Xa level prior to hospital discharge. VTE occurred in 25 patients (8.8%) and major bleeding in 3 (1.1%) patients.Conclusion A majority of critically injured patients do not meet target anti-Xa levels with 30 mg two times per day enoxaparin dosing. This study highlights the need for anti-Xa-based dose modification and efficacy of a pharmacy-driven protocol. Further optimization is warranted to mitigate VTE events.Level of evidence Therapeutic/care management, level IIIhttps://tsaco.bmj.com/content/9/1/e001287.full |
| spellingShingle | Niels D Martin Grace Martin Niziolek Lauren Mangan Cassidi Weaver Vanessa Prendergast Raymond Lamore Megan Zielke Inadequate prophylaxis in patients with trauma: anti-Xa-guided enoxaparin dosing management in critically ill patients with trauma Trauma Surgery & Acute Care Open |
| title | Inadequate prophylaxis in patients with trauma: anti-Xa-guided enoxaparin dosing management in critically ill patients with trauma |
| title_full | Inadequate prophylaxis in patients with trauma: anti-Xa-guided enoxaparin dosing management in critically ill patients with trauma |
| title_fullStr | Inadequate prophylaxis in patients with trauma: anti-Xa-guided enoxaparin dosing management in critically ill patients with trauma |
| title_full_unstemmed | Inadequate prophylaxis in patients with trauma: anti-Xa-guided enoxaparin dosing management in critically ill patients with trauma |
| title_short | Inadequate prophylaxis in patients with trauma: anti-Xa-guided enoxaparin dosing management in critically ill patients with trauma |
| title_sort | inadequate prophylaxis in patients with trauma anti xa guided enoxaparin dosing management in critically ill patients with trauma |
| url | https://tsaco.bmj.com/content/9/1/e001287.full |
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