Weight-Based Enoxaparin Achieves Adequate Anti-Xa Levels More Often in Trauma Patients: A Prospective Study
| Autor: | Ashlee E Stutsrim, Gerald J Rebo, Kristin A Rebo, Preston R. Miller, J Matthew Eady, Magdalena Collum, Andrew M. Nunn |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Trough (economics) Drug Administration Schedule 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Dose adjustment Humans Medicine Prospective Studies 030212 general & internal medicine Dosing Enoxaparin Prospective cohort study Pre and post Critically ill business.industry Body Weight 030208 emergency & critical care medicine Venous Thromboembolism General Medicine Middle Aged Anesthesia Wounds and Injuries Female business Weight based dosing Venous thromboembolism Factor Xa Inhibitors |
| Zdroj: | The American Surgeon. 87:77-82 |
| ISSN: | 1555-9823 0003-1348 |
| Popis: | Background Previous research demonstrates that twice-daily enoxaparin is inadequate for venous thromboembolic (VTE) prophylaxis in critically ill trauma patients prompting dose adjustment based on anti-Xa levels. Most studies evaluate peak anti-Xa levels; however, data suggest that trough levels are associated with decreased VTE. We evaluated trough anti-Xa levels in noncritically ill trauma patients receiving fixed or weight-based enoxaparin. Methods Peak and trough anti-Xa levels were prospectively collected from patients receiving at least 3 consecutive doses of enoxaparin (PRE). A performance improvement project prompted a change to weight-based dosing. Peak and trough levels were subsequently prospectively collected from the weight-based group (POST). Adequate peak was defined as ≥0.2 IU/mL and adequate trough as ≥0.1 IU/mL. PRE and POST groups were compared. Results 200 patients were evaluated (100 PRE, 100 POST). In the PRE group, only 34% of trough and 61% of peak anti-Xa levels were adequate compared with 82% and 97%, respectively, in the POST group ( P < .01). Median trough improved from 0.07 IU/mL to 0.2 IU/mL ( P < .01). Median peak improved from 0.22 IU/mL to 0.47 IU/mL ( P < .01). More patients achieved adequate peak and trough levels in the POST group (79% vs 31%, P < .01). 95% of patients with adequate troughs also had adequate peaks, whereas 75% with adequate peaks had adequate troughs. Discussion Traditional enoxaparin dosing in noncritically ill trauma patients results in suboptimal anti-Xa levels. Weight-based enoxaparin improves both trough and peak anti-Xa levels obviating dose adjustment. Furthermore, troughs better predict adequate anti-Xa levels. |
| Databáze: | OpenAIRE |
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