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. 2024 Mar;44(3):224-230.
doi: 10.1002/phar.2900. Epub 2023 Dec 26.

Clinical outcomes associated with anti-Xa-monitored enoxaparin for venous thromboembolism prophylaxis

John A Saunders  1   2 , Sara R Vazquez  1   3 , Joseph A Hill  1 , Daniel M Witt  1   3
Affiliations

Clinical outcomes associated with anti-Xa-monitored enoxaparin for venous thromboembolism prophylaxis

John A Saunders et al. Pharmacotherapy. 2024 Mar.

Abstract

Study objective: The objective of the study was to assess clinical outcomes (composite of any venous thromboembolism [VTE], any bleeding, and mortality) associated with anti-Xa monitoring in the 30 days following enoxaparin initiation for VTE prophylaxis.

Design: Retrospective cohort study.

Setting: Hospital within an academic healthcare system.

Patients: Propensity score-matched hospitalized adults receiving enoxaparin for VTE prophylaxis.

Intervention: Low-molecular-weight heparin anti-Xa monitoring.

Measurements and main results: During the 13-month study period, a total of 6611 patients received enoxaparin for VTE prophylaxis, 301 in the anti-Xa monitored group and 6310 in the unmonitored group (4.6% received monitoring). The mean age was 52.9 years and 52% of patients were male. The mean body mass index was 31 kg/m2 and the mean creatinine clearance was 109 mL/min. Twenty percent of patients had active cancer. The most common indication for enoxaparin prophylaxis was hospitalization for medical illness (52%) followed by nonorthopedic surgery (37%). The adjusted odds ratio for the primary outcome comparing monitored to unmonitored patients was 1.26 (95% confidence interval, 0.75-2.11). None of the between-group differences in the individual components of the composite outcome were statistically significant.

Conclusions: Thirty-day clinical outcomes in patients receiving enoxaparin for VTE prophylaxis were not improved by anti-Xa monitoring. Our results support current evidence-based guideline recommendations against anti-Xa monitoring for patients receiving enoxaparin for VTE prophylaxis.

Keywords: anti-factor Xa monitoring; drug monitoring; enoxaparin; low-molecular-weight heparin; venous thromboembolism.

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References

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