title: Increased Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in General Trauma Patients.
abstract: OBJECTIVE
  To review the evidence regarding increased enoxaparin dosing for venous thromboembolism (VTE) prophylaxis in the general trauma patient population.
  
  
  METHODS
  A search of MEDLINE databases (1946 to October 2016) was conducted using the search terms enoxaparin, thromboembolism prophylaxis, venous thromboembolism, trauma, anti-factor Xa, and weight-based dosing. Additional references were identified from a review of literature citations.
  
  
  METHODS
  Search results were limited to English-language studies conducted in humans. Trials that included only obese patients or nontrauma patients were excluded.
  
  
  RESULTS
  A total of 7 trials (958 patients) explored the use of increased dosing of enoxaparin for VTE prophylaxis in trauma patients. Patients were divided by enoxaparin dosing strategies: standard dosing of 30 mg twice daily (BID; n = 509), higher initial dosing regimen (n = 216), or dosing based on anti-FXa level adjustments (n = 233). The majority of the 42 total VTE events (64.3%) occurred in the standard dosing regimen. Within each group, VTE was reported in 5.3% of patients in the standard dosing group, 3.2% in the higher initial dosing group, and 4% in the anti-FXa adjustment group. Initial subtherapeutic anti-FXa levels occurred in 33% to 92% of standard dose patients and 9% to 39% of higher initial dose patients. The average weight-based dose required to achieve a therapeutic level ranged between 0.43 and 0.54 mg/kg/dose BID. The overall rate of bleeding was low, with 3 incidents (0.37%) reported.
  
  
  CONCLUSIONS
  Standard-dose enoxaparin prophylaxis may not be optimal for the general trauma patient population. Weight-based enoxaparin dosing (0.5 mg/kg/dose BID) is an option in trauma patients considered to be at a lower risk of bleeding complications.
authors.affiliation: 1 Southwestern Oklahoma State University College of Pharmacy, Weatherford, OK, USA.|2 Integris Southwest Medical Center, Oklahoma City, OK, USA.
authors.forename: Cheri K
authors.initials: CK
authors.lastname: Walker
authors.affiliation: 1 Southwestern Oklahoma State University College of Pharmacy, Weatherford, OK, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sandmann
authors.affiliation: 1 Southwestern Oklahoma State University College of Pharmacy, Weatherford, OK, USA.
authors.forename: Taylor J
authors.initials: TJ
authors.lastname: Horyna
authors.affiliation: 1 Southwestern Oklahoma State University College of Pharmacy, Weatherford, OK, USA.|3 Integris Baptist Medical Center, Oklahoma City, OK, USA.|4 Great Plains Family Medicine Residency Program, Oklahoma City, OK, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Gales
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001835:Body Weight; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007279:Injections, Subcutaneous; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000188:drug therapy; D054556:Venous Thromboembolism / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin
keywords: anti-factor Xa; enoxaparin; low-molecular-weight heparin; trauma; venous thromboembolism