title: Goal directed enoxaparin dosing provides superior chemoprophylaxis against deep vein thrombosis.
abstract: BACKGROUND
  Optimal enoxaparin dosing for deep venous thrombosis (DVT) prophylaxis remains elusive. Prior research demonstrated that trauma patients at increased risk for DVT based upon Greenfield's risk assessment profile (RAP) have DVT rates of 10.8% despite prophylaxis. The aim of this study was to determine if goal directed prophylactic enoxaparin dosing to achieve anti-Xa levels of 0.3-0.5IU/ml would decrease DVT rates without increased complications.
  
  
  METHODS
  Retrospective review of trauma patients having received prophylactic enoxaparin and appropriately timed anti-Xa levels was performed. Dosage was adjusted to maintain an anti-Xa level of 0.3-0.5IU/ml. RAP was determined on each patient. A score of ≥5 was considered high risk for DVT. Sub-analysis was performed on patients who received duplex examinations subsequent to initiation of enoxaparin therapy to determine the incidence of DVT.
  
  
  RESULTS
  306 patients met inclusion criteria. Goal anti-Xa levels were met initially in only 46% of patients despite dosing of >40mg twice daily in 81% of patients; however, with titration, goal anti-Xa levels were achieved in an additional 109 patients (36%). An average enoxaparin dosage of 0.55mg/kg twice daily was required for adequacy. Bleeding complications were identified in five patients (1.6%) with three requiring intervention. There were no documented episodes of HIT. Subsequent duplex data was available in 197 patients with 90% having a RAP score >5. Overall, five DVTs (2.5%) were identified and all occurred in the high-risk group. All patients were asymptomatic at the time of diagnosis.
  
  
  CONCLUSIONS
  An increased anti-Xa range of 0.3-0.5IU/ml was attainable but frequently required titration of enoxaparin dosage. This produced a lower rate of DVT than previously published without increased complications.
authors.affiliation: Department of Surgery, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, United States. Electronic address: Tammy_Kopelman@dmgaz.org.
authors.forename: Tammy R
authors.initials: TR
authors.lastname: Kopelman
authors.affiliation: Department of Surgery, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, United States. Electronic address: Jarvis.Walters3@mihs.org.
authors.forename: Jarvis W
authors.initials: JW
authors.lastname: Walters
authors.affiliation: Department of Surgery, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, United States. Electronic address: James_Bogert@dmgaz.org.
authors.forename: James N
authors.initials: JN
authors.lastname: Bogert
authors.affiliation: Department of Surgery, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, United States. Electronic address: ubashara@asu.edu.
authors.forename: Usmaan
authors.initials: U
authors.lastname: Basharat
authors.affiliation: Department of Surgery, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, United States. Electronic address: Paola_Pieri@dmgaz.org.
authors.forename: Paola G
authors.initials: PG
authors.lastname: Pieri
authors.affiliation: Department of Surgery, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, United States. Electronic address: Karole_Davis@dmagz.org.
authors.forename: Karole M
authors.initials: KM
authors.lastname: Davis
authors.affiliation: Department of Surgery, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, United States. Electronic address: Asia.Quan@mihs.org.
authors.forename: Asia N
authors.initials: AN
authors.lastname: Quan
authors.affiliation: Department of Surgery, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, United States. Electronic address: Sydney_Vail@dmgaz.org.
authors.forename: Sydney J
authors.initials: SJ
authors.lastname: Vail
authors.affiliation: Department of Surgery, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, United States. Electronic address: Melissapressman@hotmail.com.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Pressman
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D017984:Enoxaparin / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000150:complications / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin
keywords: Anti-factor Xa; Deep venous thrombosis; Enoxaparin; Prophylaxis; Trauma