S. Morrissey1, N. Ingalls1, P. Chestovich1, D. Frisch2, F. Simon2, D. Fraser1, J. Fildes1 1University Of Nevada School Of Medicine,Las Vegas, NV, USA 2University Medical Center Of Southern Nevada,Las Vegas, NV, USA
Introduction: Trauma patients are known to have higher incidences of VTE (venous thromboembolism) when compared to other patient populations. The ideal dose of Enoxaparin for adequate VTE prophylaxis in the critically ill trauma patient has yet to be determined. Our dosing regimen attempts to minimize missed Enoxaparin doses while still achieving adequate factor Xa levels (anti-factor Xa activity). This study evaluates the efficacy of this regimen and examines the patient factors that may contribute to its inadequacy.
Methods: This is a prospective observational study performed in our trauma intensive care unit (TICU). We identified all critically ill trauma patients over the age of 18 admitted to the TICU requiring chemical VTE prophylaxis between December 2013 and January 2014. These patients were started on Enoxaparin 40 mg subcutaneously nightly. Peak factor Xa levels were drawn 4 hours after the third dose. Adequate prophylaxis was defined at factor Xa levels of greater than 0.2. Patient injury patterns and demographics were collected for analysis.
Results: A total of 25 critically ill trauma patients admitted to the TICU were started on chemical prophylaxis. 21 patients (84%) had adequate peak factor Xa levels (Group 1) vs 4 patients (16%) that had inadequate levels (Group 2). When comparing demographics and injury patterns using a T-test and Pearson’s chi-squared test between the two groups, Group 2 had a statistically higher mean BMI and incidence of lower extremity fractures and spine injuries. 2/4 (50%) of the patients in group 2 developed superficial venous thrombosis. There were no missed doses in either group.
Conclusion: Based on our data, Enoxaparin 40 mg given once nightly provides adequate VTE prophylaxis in the majority of critically ill trauma patients. Not only do our rates of adequate prophylaxis using factor Xa levels surpass those found in the current literature, but this regimen also minimizes missed doses, which could potentially lead to lower levels of VTE.