Enoxaparin 40mg Twice Daily with Peak Anti-Xa Adjustments is Safe and Necessary to Achieve Therapeutic Chemoprophylaxis in Burn-Injured Patients.

Autor:	Pinto DN; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA.; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA., Lee S; Department of Pharmacy, MedStar Washington Hospital Center, Washington, DC, USA., Johnson C; Department of Pharmacy, MedStar Washington Hospital Center, Washington, DC, USA., Halabi R; Department of Pharmacy, MedStar Washington Hospital Center, Washington, DC, USA., Le TD; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA., Moffatt LT; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA.; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA.; Department of Biochemistry and Molecular & Cellular Biology, Georgetown University School of Medicine, Washington, DC, USA., Carney BC; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA.; Department of Biochemistry and Molecular & Cellular Biology, Georgetown University School of Medicine, Washington, DC, USA., Mathew SK; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA., McLawhorn M; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA., Tejiram S; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA.; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA.; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, USA., Travis TE; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA.; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA.; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, USA., Shupp JW; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA.; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA.; Department of Biochemistry and Molecular & Cellular Biology, Georgetown University School of Medicine, Washington, DC, USA.; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, USA.
Jazyk:	angličtina
Zdroj:	Journal of burn care & research : official publication of the American Burn Association [J Burn Care Res] 2024 Dec 11. Date of Electronic Publication: 2024 Dec 11.
DOI:	10.1093/jbcr/irae201
Abstrakt:	Burn injury results in hypercoagulability and an increased venous thromboembolism risk. However, the most effective chemoprophylaxis for burn-injured patients has yet to be elucidated. Therefore, this study aims to identify the safety and efficacy of a burn center's venous thromboembolism protocol modification which increased the dose of enoxaparin from 40mg daily to 40mg twice daily with peak anti-Xa level adjustments. It was hypothesized that this change would not increase bleeding complications and would decrease venous thromboembolism rates. All adult, burn-injured patients admitted to a regional burn center were retrospectively reviewed one year before and after the implementation of this protocol modification. There were no differences in demographics, injury characteristics, or hospital length of stay between the pre- (n=432) and post-protocol modification (n=407) groups. Bleeding complications did not increase in the post-protocol group, including intraoperative blood loss (50 vs 25cc), the total number of transfusions (9.0 vs 6.0 units), and GI bleeding events (0.7 vs 0.2%) (all p>0.05). Most patients receiving enoxaparin 40mg twice daily achieved an initial therapeutic level based on peak anti-Xa measurements (46.5%), yet the rate of venous thromboembolisms between pre- and post-protocol groups was not statistically different (1.4 vs 0.7%, p=0.5072). Factors associated with an initial sub- or supratherapeutic peak anti-Xa level were percent total body surface area, weight, body mass index, and creatinine clearance. Overall, this study demonstrated that a higher dose of enoxaparin (40mg twice daily) with peak anti-Xa level adjustments was safe in burn-injured patients and necessary to obtain therapeutic levels of chemoprophylaxis. (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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