Weight-based enoxaparin dosing for venous thromboembolism prophylaxis in the obese trauma patient.
BACKGROUND
Limited data exist regarding the efficacy of weight-based dosing of low-molecular weight heparin for venous thromboembolism (VTE) prophylaxis in obese trauma patients.


METHODS
Consecutive obese trauma patients were placed on a weight-based protocol for VTE prophylaxis (enoxaparin .5 mg/kg subcutaneously every 12 hours). Peak anti-Xa levels were drawn, and bilateral lower extremity duplex ultrasound was performed. The incidence of VTE and bleeding complications were recorded.


RESULTS
Eighty-six patients met the study criteria. Seventy-four patients achieved target prophylactic anti-Xa concentrations, with a mean level of .42 ± .01 IU/mL. Eighteen patients were found to have deep vein thrombosis. However, in 16 of these patients, deep vein thrombosis was diagnosed before weight-based low-molecular weight heparin initiation. No bleeding complications occurred, and no symptomatic pulmonary emboli were identified.


CONCLUSIONS
In obese trauma patients, weight-based enoxaparin is an efficacious regimen that provides adequate VTE prophylaxis, as measured by anti-Xa levels, and appears to be safe without bleeding complications.
Trauma Services, Intermountain Medical Center, 5121 S Cottonwood Street, Murray, UT 84157, USA. Electronic address: annika.bickford@imail.org.
Annika
A
Bickford
Sarah
S
Majercik
Joseph
J
Bledsoe
Katie
K
Smith
Rob
R
Johnston
Justin
J
Dickerson
Tom
T
White
D000925:Anticoagulants / Q000008:administration & dosage; D015992:Body Mass Index; D004305:Dose-Response Relationship, Drug; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007279:Injections, Subcutaneous; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications*
D000925:Anticoagulants; D017984:Enoxaparin
Anti-Xa level; Enoxaparin; Obese; Trauma; VTE prophylaxis; Venous thromboembolism prophylaxis