Evaluation of Venous Thromboembolism Prevention in High-Risk Trauma Patients: A Prospective, Randomized Trial of Standard Enoxaparin Versus Two Anti-Xa Adjusted Enoxaparin Dosing Strategies
Abstract
The impact of antithrombin III activity (AT-III) and on prophylactic enoxaparin serum trough anti-factor Xa concentration (anti-Xa) has not been evaluated. In addition, the optimal strategy for enoxaparin dose adjustment to attain target anti-Xa trough concentrations is unknown in high-risk trauma patients. The objective of this study was to determine if AT-III activity affects enoxaparin anti-Xa target attainment and to evaluate two enoxaparin dose adjustment strategies in patients with low anti-Xa concentrations. We conducted a single-center, prospective, randomized clinical trial of adult, high-risk trauma patients admitted to a level 1 trauma center over a 2-year period. Patients were eligible for inclusion if prescribed enoxaparin 30 mg subcutaneously every 12 hours for venous thromboembolism chemoprophylaxis based on a Greenfield Risk Assessment Profile score of 5 or more. Coordinated serum AT-III, anti-Xa, and thromboeslastogram samples were drawn 8 hours after the third dose of enoxaparin. Patients with anti-Xa 0.1 IU/mL served as the control group, while patients with anti-Xa < 0.1 IU/mL were the intervention group. Intervention group patients were randomized to one of two dose adjustment strategies: 1) enoxaparin 40 mg every 12 hours with escalation to 50 mg every 12 hours based on repeat anti-Xa (group 1) or 2) enoxaparin 30 mg every 8 hours (group 2). In total, 103 patients were studied..
Document Details
- Document Type
- Technical Report
- Publication Date
- Aug 10, 2018
- Accession Number
- AD1062074
Entities
People
- Bryce H. Robinson
- Carolyn D. Philpott
- Christopher A. Droege
- Dennis Hanseman
- Devin Wakefield
- Dina Gomma
- Eric W. Mueller
- Joel Elterman
- Joseph R. Dowd
- Krishna Athota
- Megan L. Webb
- Molly Droege
- Neil E. Ernst
- Travis Gerlach
Organizations
- University of Cincinnati