Frontiers in surgery · 2026
Weight-based, anti-Xa guided enoxaparin after spine trauma surgery: target attainment and safety in a retrospective cohort.
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Sheinberg Dallas L, Johnston David Travis, O'Reilly Brendan T, Castro Gabriel Galan, Khazaal Jawad R, Withrow Joseph S, Trimble Duncan J, Chandra Ankush, Lim Anthony J, Sheinberg Derek S, Zaragoza Jennifer, Li Wen, Williams John R
Аннотация
BACKGROUND AND PURPOSE: Patients undergoing surgery for traumatic spine injuries have a high risk of venous thromboembolism (VTE). Standard fixed or weight-based enoxaparin regimens may leave some patients below prophylactic anti-factor Xa (anti-Xa) target ranges. Whether anti-Xa-guided enoxaparin dose adjustment can be implemented while maintaining acceptable observed bleeding outcomes has not been studied specifically in postoperative spine trauma patients. This study evaluates anti-Xa target attainment, symptomatic VTE, and safety outcomes after anti-Xa-guided enoxaparin titration.
METHODS: We performed a retrospective cohort study of adults (≥18 years old) who underwent operative treatment for traumatic spine injuries at a Level I trauma center. All patients received weight-based enoxaparin starting 24 h postoperatively (30 mg every 12 h if <90 kg, 40 mg every 12 h if ≥90 kg) plus mechanical VTE prophylaxis and early mobilization. In the anti-Xa cohort, levels were obtained 4 h after the third dose (target 0.2-0.4 IU/mL) and doses were adjusted by 10 mg if outside this range. A comparison cohort received the same initial dosing without anti-Xa monitoring. The primary outcome was symptomatic postoperative VTE. Secondary outcomes included bleeding requiring transfusion, spinal epidural hematoma, hospital length of stay, and ambulation at discharge.
RESULTS: A total of 354 patients were included (170 anti-Xa; 184 fixed dose). Symptomatic VTE was rare and similar between groups (1.1% vs. 1.6%). No postoperative epidural hematomas occurred. In the anti-Xa cohort, 28% required dose escalation and 7% required more than one adjustment. In exploratory adjusted analyses, bleeding requiring transfusion and length of stay did not differ between groups.
CONCLUSIONS: Weight-based enoxaparin with anti-Xa-guided titration was feasible after spine trauma surgery and identified a substantial subset of patients below the prespecified prophylactic anti-Xa target range. Protocol-based dose escalation was not associated with an observed increase in bleeding requiring transfusion, and no postoperative epidural hematomas occurred. Larger prospective studies are needed to determine whether improved anti-Xa target attainment translates into lower VTE rates.
METHODS: We performed a retrospective cohort study of adults (≥18 years old) who underwent operative treatment for traumatic spine injuries at a Level I trauma center. All patients received weight-based enoxaparin starting 24 h postoperatively (30 mg every 12 h if <90 kg, 40 mg every 12 h if ≥90 kg) plus mechanical VTE prophylaxis and early mobilization. In the anti-Xa cohort, levels were obtained 4 h after the third dose (target 0.2-0.4 IU/mL) and doses were adjusted by 10 mg if outside this range. A comparison cohort received the same initial dosing without anti-Xa monitoring. The primary outcome was symptomatic postoperative VTE. Secondary outcomes included bleeding requiring transfusion, spinal epidural hematoma, hospital length of stay, and ambulation at discharge.
RESULTS: A total of 354 patients were included (170 anti-Xa; 184 fixed dose). Symptomatic VTE was rare and similar between groups (1.1% vs. 1.6%). No postoperative epidural hematomas occurred. In the anti-Xa cohort, 28% required dose escalation and 7% required more than one adjustment. In exploratory adjusted analyses, bleeding requiring transfusion and length of stay did not differ between groups.
CONCLUSIONS: Weight-based enoxaparin with anti-Xa-guided titration was feasible after spine trauma surgery and identified a substantial subset of patients below the prespecified prophylactic anti-Xa target range. Protocol-based dose escalation was not associated with an observed increase in bleeding requiring transfusion, and no postoperative epidural hematomas occurred. Larger prospective studies are needed to determine whether improved anti-Xa target attainment translates into lower VTE rates.