Underdosing of Prophylactic Enoxaparin Is Common in Orthopaedic Trauma and Predicts 90-Day Venous Thromboembolism

Objectives: To determine the feasibility and impact of real-time anti-factor Xa (aFXa) level monitoring and enoxaparin dose adjustment in orthopaedic trauma. To examine the adequacy of standard fixed-dose enoxaparin chemoprophylaxis and to examine whether patient-specific factors influence enoxaparin metabolism. Design: Prospective cohort. Setting: Academic Level-I trauma center. Patients: Postoperative adult orthopaedic trauma patients undergoing acute fracture or nonunion surgery of the pelvis, acetabulum, or lower extremity placed on 30 mg of enoxaparin twice daily. Intervention: Peak steady-state aFXa levels were drawn with a goal range of 0.2–0.4 IU/mL. Patients with out-of-range levels underwent a 10-mg dose adjustment followed by repeat aFXa draws. Main Outcome Measures: Peak and trough aFXa levels, 90-day venous thromboembolism, and bleed events. Results: Of 109 enrolled patients, 43% had inadequate initial peak aFXa levels (aFXa
Source: Journal of Orthopaedic Trauma - Category: Orthopaedics Tags: Original Article Source Type: research