M. L. Pickett1, L. R. Taveras1, J. B. Imran1, S. W. Ross1, T. D. Madni1, H. B. Cunningham1, S. Park1, M. Zhou1, E. Huang1, J. C. Kubasiak1, M. W. Cripps1 1University Of Texas Southwestern Medical Center,Department Of Surgery, Division Of General And Acute Care Surgery,Dallas, TX, USA
Introduction:
Novel research suggests current low molecular-weight heparin dosing protocols for venous thromboembolism prophylaxis are inadequate. Reliable predictors of sub-prophylactic Xa levels remain elusive. We hypothesize hypofibrinolysis, as measured by rotational thromboelastometry (ROTEM), is associated with sub-prophylactic anti-Xa levels. We aim to evaluate the ability of admission ROTEM to predict sub-prophylactic Xa levels after enoxaparin administration.
Methods:
Retrospective review of patients admitted to the Parkland SICU from July 2016 to June 2017 who received enoxaparin 40 mg twice daily (BID), had appropriately timed draw of anti-Xa levels, and had ROTEM drawn within 24 hours of admission. Clinical and ROTEM data were collected and subjects were grouped in prophylactic and sub-prophylactic cohorts. Hyperfibrinolysis was defined as maximum lysis percentage (ML) >15% and hypofibrinolysis was defined as ML <3%.
Results:
A total of 55 patients were included and 23.6% had penetrating injuries. Hyperfibrinolysis was found in two patients (3.6%) and hypofibrinolysis in 14 (25.5%). Thirty-two patients (58.2%) had prophylactic Xa levels. Prophylactic and sub- prophylactic groups were similar in age, body mass index, and injury severity scale. VTE events occurred in four patients (7.2%). Hypofibrinolysis was not significantly associated with sub-prophylactic anti-Xa levels (p= .763). In addition, VTE rates were not significantly different between groups.
Conclusion:
Currently, it is not possible to predict sub-prophylactic anti-Xa levels after enoxaparin administration using ROTEM. Hypofibrinolysis was not found to be associated with sub-prophylactic anti-Xa levels or VTE events.
