Clinical Characteristics of Trauma Patients Requiring Dosing Adjustments of Enoxaparin in TEN Prevention
Injuries and trauma surgical procedures represent a significant risk factor for the development of thromboembolic disease (TEN). Routine thromboprophylaxis is thus recommended for trauma patients, often in the form of low molecular weight heparins (LMWH), including enoxaparin. A recently published study evaluated factors associated with the need for higher dosing of enoxaparin to achieve effective prophylactic levels.
Introduction
To confirm the effective level of LMWH in circulation, monitoring the anti-Xa parameter (the so-called peak level 4 hours after administering enoxaparin, or the trough level taken before administering the next dose − i.e., depending on the situation, after 12 or 24 hours) and adjusting the dosage based on the detected values is important. However, results from several published studies have shown that enoxaparin is often administered in insufficient doses, which reduces its effectiveness. A recently published study examined the factors associated with the need for higher dosing of enoxaparin to achieve the targeted trough anti-Xa level in trauma patients.
Evaluated Population
The retrospective analysis included patients who suffered trauma from August 2014 to February 2018 and were administered enoxaparin in doses adjusted according to the trough anti-Xa level. The analysis compared groups undergoing enoxaparin therapy at doses < 50 mg every 12 hours with those receiving therapy at doses > 50 mg every 12 hours.
Results
A total of 246 patients were included in the study, of which 32 (13%) required enoxaparin doses > 50 mg every 12 hours to reach target anti-Xa values. Factors associated with the need for higher doses included male gender (96.8 vs. 3.2%; p < 0.01), younger age (39.5 vs. 52.7 years; p < 0.01), higher creatinine clearance (125.9 vs. 93.7 ml/min; p < 0.01), larger body surface area (2 vs. 1.8 m2; p < 0.01), and higher injury severity score (18.4 vs. 10.8; p < 0.01). Height, weight, and BMI values were not evaluated as significant factors. In a regression analysis, creatinine clearance was the only independent predictor of the need for a higher enoxaparin dose.
Conclusion
The study results indicated that trauma patients requiring higher dosing of enoxaparin to achieve the target prophylactic trough anti-Xa level show significantly higher creatinine clearance. Patients with higher creatinine clearance might benefit from an initially higher dose of enoxaparin to achieve the target anti-Xa level in a shorter time frame in TEN prevention.
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Source: Hashim Y. M., Dhillon N. K., Veatch J. M. et al. Clinical characteristics associated with higher enoxaparin dosing requirements for venous thromboembolism prophylaxis in trauma patients. Am Surg 2021; 87 (7): 1177–1181, doi: 10.1177/0003134820979574.
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