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
Technical Report,01 Sep 2014,31 Mar 2018
CINCINNATI UNIV OH CINCINNATI United States
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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 IUmL served as the control group, while patients with anti-Xa 0.1 IUmL 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..
- Medicine and Medical Research