Evaluation of Weight-Based Enoxaparin Dosing and Monitoring for VTE Prophylaxis in Trauma Patients Ashley Taylor, Ellen Huang, Tim Robinson, Cassandra White Augusta University Medical Center/ University of Georgia College of Pharmacy - Augusta, GA
Background/Purpose: Trauma patients are at an increased risk of developing venous thromboembolism (VTE), and enoxaparin is considered the standard of care for VTE prophylaxis in this population. The current standard of practice for VTE prophylaxis in trauma patients at AU Medical Center is weight-based enoxaparin dosed at 0.5 mg/kg subcutaneously every 12 hours that is monitored via anti-factor Xa levels. While there is literature suggesting higher doses of enoxaparin are more effective in achieving goal anti-factor Xa levels, there limited information regarding the use of weight-based dosing across all weights in the trauma population. The purpose of this project is to evaluate the utility of routine anti-factor Xa level monitoring for trauma patients initiated on weight-based enoxaparin for VTE prophylaxis and identify patient populations where monitoring would be necessary.
Methodology: The inclusion criteria were adult patients admitted to the trauma service who received at least 3 consecutive doses of enoxaparin 0.5 mg/kg every 12 hours for VTE prophylaxis prior to an anti-factor Xa peak. Patients were excluded if they had a creatinine clearance of less than 30 mL/min, baseline platelet count of less than 50,000/mm3, allergy to heparin, history of heparin-induced thrombocytopenia, were pregnant or received therapeutic anticoagulation prior to trauma admission. The primary endpoint was the percentage of patients who fell within the goal anti-Xa peak range. The secondary endpoints included the incidence of VTE and clinically significant bleeding. An analysis was completed to determine if a correlation exists between anti-Xa peaks not within the goal range and certain patient characteristics, including critical illness and obesity.
Presentation Objective: Discuss the utility of routine anti-factor Xa monitoring of weight-based enoxaparin dosing for VTE prophylaxis in trauma patients
Self-Assessment: Are anti-factor Xa levels necessary measurements to routinely monitor in trauma patients receiving weight-based enoxaparin dosing for VTE prophylaxis?
