P. Martinez Quinones1, A. Talukder1, R. Latremouille3, T. Robinson2, A. Newsome2, C. White1 1Medical College Of Georgia,Surgery,Augusta, GA, USA 2Medical College Of Georgia,Pharmacy,Augusta, GA, USA 3Medical College Of Georgia,Augusta, GA, USA
Introduction: ? Traumatic injury is a major risk factor for the development of venous thromboembolic events (VTE), and is associated with increased bleeding risk. VTEs increase length of stay, cost and are associated with elevated morbidity and mortality in trauma patients. Optimal VTE pharmacologic prophylaxis in trauma patients remains unknown. Recent studies suggest that standard dosing of enoxaparin (30mg SQ Q12hrs) leads to sub-therapeutic levels of anti-Factor Xa, which are associated with increased risk for the development of VTE. We aimed to determine the efficiency of standard-dose versus weight-adjusted dose of enoxaparin.?
Methods: As a quality improvement measure for medication use evaluation we conducted a retrospective registry review and data analysis. Patients with an initial trauma admission from January-December 2016 who received standard-dose (STD) or weight-adjusted (WT) enoxaparin were included. Patients <18 years, prior/current anticoagulation, prior VTE, known malignancy, autoimmune disorder and/or severe traumatic brain injury (TBI) were excluded. The primary outcome was incidence of VTE, including pulmonary embolism (PE) and deep venous thrombosis (DVT). Secondary outcomes included bleeding complications and length of stay.?
Results: We identified 142 patients who met inclusion criteria. Both groups (STD dose and WT dose) had comparable baseline characteristics for age, gender, race/ethnicity, mean weight and tobacco use. Mild-to-moderate TBI patients were similarly distributed, STD n=17, WT n=12 (p=0.81). VTE incidence was significantly different, STD n=17 and WT n=3 (p=0.03). No difference noted in length of stay (p=0.35) or time to onset of prophylaxis (p=0.93). No bleeding complications reported.?
Conclusion: Weight-adjusted enoxaparin dose for VTE prophylaxis decreased the risk of VTE in our trauma population sample without an increase in bleeding complications or expansion of intracranial hemorrhage in traumatic brain injury patients. Our ultimate goal is to develop a protocol for VTE prophylaxis that is safe and beneficial in patients with traumatic injuries.?
