Standard Dosing of Enoxaparin for Venous Thromboembolism Prophylaxis Is Not Sufficient for Most Patients Within a Trauma Intensive Care Unit

Recent reports confirm that the standard dose of enoxaparin in obese patients is often subtherapeutic, leading to a higher incidence of venous thromboembolism. All patients receiving subcutaneous enoxaparin 30 mg twice a day (b.i.d.) for venous thromboembolism prophylaxis were prospectively enrolled...

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Bibliographic Details
Published in:The American surgeon 2015-09, Vol.81 (9), p.889-892
Main Authors: Rostas, Jack W, Brevard, Sidney B, Ahmed, Naveed, Allen, John, Thacker, Derek, Replogle, William H, Gonzalez, Richard P, Frotan, Amin M, Simmons, Jon D
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Anticoagulants - administration & dosage
Body Mass Index
Dose-Response Relationship, Drug
Enoxaparin - administration & dosage
Female
Follow-Up Studies
Humans
Injections, Subcutaneous
Intensive Care Units
Male
Middle Aged
Obesity - complications
Prospective Studies
Trauma Centers
Treatment Outcome
Venous Thromboembolism - etiology
Venous Thromboembolism - prevention & control
Wounds and Injuries - complications
Young Adult
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Summary:Recent reports confirm that the standard dose of enoxaparin in obese patients is often subtherapeutic, leading to a higher incidence of venous thromboembolism. All patients receiving subcutaneous enoxaparin 30 mg twice a day (b.i.d.) for venous thromboembolism prophylaxis were prospectively enrolled in this study. Trough antiXa levels were obtained and any level less than 0.1 IU/mL was considered subtherapeutic and the final dosage requirement was recorded. Body mass index (BMI), abdominal wall thickness, and fluid balance were collected. Thirty-four patients were prospectively enrolled in the study, 14 (50%) of which had a BMI >30. Sixty-five per cent of obese patients were initially nontherapeutic, compared with 53 per cent of the nonobese (P = 0.73). However, elevated BMI (P < 0.05) and abdominal wall thickness (P < 0.05) correlated to an increased final dose required to attain an anti Xa ≥0.1 when not initially therapeutic, whereas fluid balance demonstrated no correlation (P = 0.232). Subcutaneous enoxaparin dosing of 30 mg b.i.d. is not sufficient for the majority adult trauma patients in the intensive care unit, regardless of BMI. When enoxaparin 30 mg b.i.d. is initially subtherapeutic, obese patients may require a larger dose necessary to achieve necessary anticoagulation.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313481508100923