Increased Prophylactic Enoxaparin Dosing Is Associated With Improved Achievement of Target anti-Xa Levels; Implementation of the Western Trauma Association Venous-Thromboembolism Guidelines.

BACKGROUND: Evidence suggests that standard enoxaparin dosing for burn and trauma patients results in sub-optimal target thromboprophylactic plasma anti-Xa levels in up to 84% of the patients, potentially leading to increased incidence of venous thromboembolism (VTE). More intensive dosing regimens have been suggested; however, few studies have evaluated these protocols in trauma/burn patient populations.

METHODS: A retrospective chart review of an American Burn Association-verified burn and American College of Surgeons-verified level 1 trauma center from June 2022 until July 2023 identified patients initiated on a higher dosing enoxaparin protocol for VTE prophylaxis in accordance with recent Western Trauma Association guidelines. Patients were included if they were at least 18 years of age, dosed according to protocol criteria, and received at least three sequential doses of enoxaparin with appropriately timed peak plasma anti-Xa levels to monitor efficacy.

RESULTS: Two hundred forty five patients were screened with 196 patients included for analysis. 24.5% of the patients dosed according to the protocol did not reach target peak plasma anti-Xa levels (0.2-0.5 IU/mL). Burn patients were more likely to achieve target anti-Xa levels than trauma patients (81.1% versus 65.2%, P = 0.016). An association between severe burns and inability to meet anti-Xa goals was also noted.

CONCLUSIONS: Utilization of a higher dose enoxaparin protocol for VTE prophylaxis has an improved likelihood of achieving plasma anti-Xa targets compared to standard dosing strategies, however, almost 23% of the patients were still underdosed. Increased enoxaparin dosing targeted to peak plasma anti-Xa levels and the impact on VTE reduction in severe burn and trauma patients should be further evaluated.