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Multicenter Study
. 2024 Mar;44(3):258-267.
doi: 10.1002/phar.2904. Epub 2024 Jan 8.

Multicenter study evaluating target attainment of anti-Factor Xa levels using various enoxaparin prophylactic dosing practices in adult trauma patients

Tyler Chanas  1 , Gabrielle Gibson  2 , Elizabeth Langenstroer  1 , David J Herrmann  3 , Thomas W Carver  3 , Kaitlin Alexander  4 , Sai Ho Jason Chui  5 , Lisa Rein  6 , Michael Ha  7 , Kaylee M Maynard  8 , Kristen Bamberg  9 , Mary O'Keefe  10 , Marisa O'Brien  7 , Mariela Cardona Gonzalez  11 , Brandon Hobbs  12 , Mehrnaz Pajoumand  5 , William J Peppard  3
Affiliations
Multicenter Study

Multicenter study evaluating target attainment of anti-Factor Xa levels using various enoxaparin prophylactic dosing practices in adult trauma patients

Tyler Chanas et al. Pharmacotherapy. 2024 Mar.

Abstract

Study objective: Enoxaparin is standard of care for venous thromboembolism (VTE) prophylaxis in adult trauma patients, but fixed-dose protocols are suboptimal. Dosing based on body mass index (BMI) or total body weight (TBW) improves target prophylactic anti-Xa level attainment and reduces VTE rates. A novel strategy using estimated blood volume (EBV) may be more effective based on results of a single-center study. This study compared BMI-, TBW-, EBV-based, and hybrid enoxaparin dosing strategies at achieving target prophylactic anti-Factor Xa (anti-Xa) levels in trauma patients.

Design: Multicenter, retrospective review.

Data source: Electronic health records from participating institutions.

Patients: Adult trauma patients who received enoxaparin twice daily for VTE prophylaxis and had at least one appropriately timed anti-Xa level (collected 3 to 6 hours after the previous dose after three consecutive doses) from January 2017 through December 2020. Patients were excluded if the hospital-specific dosing protocol was not followed or if they had thermal burns with > 20% body surface area involvement.

Intervention: Dosing strategy used to determine initial prophylactic dose of enoxaparin.

Measurements: The primary end point was percentage of patients with peak anti-Xa levels within the target prophylactic range (0.2-0.4 units/mL).

Main results: Nine hospitals enrolled 742 unique patients. The most common dosing strategy was based on BMI (43.0%), followed by EBV (29.0%). Patients dosed using EBV had the highest percentage of target anti-Xa levels (72.1%). Multiple logistic regression demonstrated EBV-based dosing was significantly more likely to yield anti-Xa levels at or above target compared to BMI-based dosing (adjusted odds ratio (aOR) 3.59, 95% confidence interval (CI) 2.29-5.62, p < 0.001). EBV-based dosing was also more likely than hybrid dosing to yield an anti-Xa level at or above target (aOR 2.30, 95% CI 1.33-3.98, p = 0.003). Other pairwise comparisons between dosing strategy groups were nonsignificant.

Conclusions: An EBV-based dosing strategy was associated with higher odds of achieving anti-Xa level within target range for enoxaparin VTE prophylaxis compared to BMI-based dosing and may be a preferred method for VTE prophylaxis in adult trauma patients.

Keywords: blood volume; body mass index; body weight; enoxaparin; prophylaxis; trauma.

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References

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