title: Alternative dosing of prophylactic enoxaparin in the trauma patient: is more the answer?
abstract: BACKGROUND
  Inadequate anti-factor Xa levels and increased venous thromboembolic events occur in trauma patients receiving standard prophylactic enoxaparin dosing. The aim of this study was to test the hypothesis that higher dosing (40 mg twice daily) would improve peak anti-Xa levels and decrease venous thromboembolism.
  
  
  METHODS
  A retrospective review was performed of trauma patients who received prophylactic enoxaparin and peak anti-Xa levels over 27 months. Patients were divided on the basis of dose: group A received 30 mg twice daily, and group B received 40 mg twice daily. Demographics and rates of venous thromboembolism were compared between dose groups and patients with inadequate or adequate anti-Xa levels.
  
  
  RESULTS
  One hundred twenty-four patients were included, 90 in group A and 34 in group B. Demographics were similar, except that patients in group B had a higher mean body weight. Despite this, only 9% of group B patients had inadequate anti-Xa levels, compared with 33% of those in group A (P = .01). Imaging studies were available in 69 patients and revealed 8 venous thromboembolic events (P = NS, group A vs group B) with significantly more venous thromboembolic events occurring in patients with low anti-Xa levels (P = .02).
  
  
  CONCLUSIONS
  Although higher dosing of enoxaparin led to improved anti-Xa levels, this did not equate to a statistical decrease in venous thromboembolism.
authors.affiliation: Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt Street, Phoenix, AZ 85008, USA. Electronic address: Tammy_Kopelman@dmgaz.org.
authors.forename: Tammy R
authors.initials: TR
authors.lastname: Kopelman
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Neill
authors.forename: Paola G
authors.initials: PG
authors.lastname: Pieri
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Salomone
authors.forename: Scott T
authors.initials: ST
authors.lastname: Hall
authors.forename: Asia
authors.initials: A
authors.lastname: Quan
authors.forename: Jordan R
authors.initials: JR
authors.lastname: Wells
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Pressman
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D017984:Enoxaparin / Q000008:administration & dosage*; D015951:Factor Xa / Q000378:metabolism; D065427:Factor Xa Inhibitors; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D065427:Factor Xa Inhibitors; D015951:Factor Xa
keywords: Anticoagulation; Anti–factor Xa; LMWH; Low–molecular weight heparin; VTE; Venous thromboembolism