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Enoxaparin and Trauma

Julia Coleman, Mustafa Baldawi, David Heidt
BACKGROUND: This research study aims to identify the effect of anticoagulation status on hospital course, complications, and outcomes among geriatric fall trauma patients. METHODS: The study design is a retrospective cohort study, looking at fall trauma among patients aged 60 to 80 years from 2009 to 2013 at a university hospital in the United States. The statistical analysis, conducted with SPSS software with a threshold for statistical significance of P < ...
October 1, 2016: American Journal of Surgery
Rajeev B Ahuja, Priya Bansal, Gaurav S Pradhan, Manju Subberwal
INTRODUCTION: Morbidity and mortality from venous thrombo-embolism (VTE) remains a significant problem for trauma and medical patients and there are established guidelines for prophylaxis in these patients. However, the efficacy and safety of VTE prophylaxis in thermally injured patients continue to be elusive as it has never been studied in a prospective, randomized fashion. Selective use of VTE prophylaxis, for high risk patients, is practiced by some burn units even if objective evidence is lacking for majority of risk factors enunciated in burn patients...
September 12, 2016: Burns: Journal of the International Society for Burn Injuries
George A Singer, Gina Riggi, Charles A Karcutskie, Tanaz M Vaghaiwalla, Howard M Lieberman, Enrique Ginzburg, Nicholas Namias, Edward B Lineen
BACKGROUND: Appropriate prophylaxis against venous thromboembolism (VTE) remains undefined. This study evaluated an anti-Xa-guided enoxaparin thromboprophylaxis protocol on the incidence of VTE in high-risk trauma patients based upon Greenfield's Risk Assessment Profile (RAP) score. METHODS: This is a retrospective observational study of patients admitted to a trauma ICU over a 12-month period. Patients were included if they received anti-Xa-guided enoxaparin thromboprophylaxis...
August 3, 2016: Journal of Trauma and Acute Care Surgery
Christopher R Connelly, Philbert Y Van, Kyle D Hart, Scott G Louis, Kelly A Fair, Anfin S Erickson, Elizabeth A Rick, Erika C Simeon, Eileen M Bulger, Saman Arbabi, John B Holcomb, Laura J Moore, Martin A Schreiber
Importance: Prophylactic enoxaparin is used to prevent venous thromboembolism (VTE) in surgical and trauma patients. However, VTE remains an important source of morbidity and mortality, potentially exacerbated by antithrombin III or anti-Factor Xa deficiencies and missed enoxaparin doses. Recent data suggest that a difference in reaction time (time to initial fibrin formation) greater than 1 minute between heparinase and standard thrombelastogram (TEG) is associated with a decreased risk of VTE...
August 3, 2016: JAMA Surgery
Ara Ko, Megan Y Harada, Galinos Barmparas, Kevin Chung, Russell Mason, Dorothy A Yim, Navpreet Dhillon, Daniel R Margulies, Bruce L Gewertz, Eric J Ley
Importance: Trauma patients are at high risk for developing venous thromboembolism (VTE). The VTE rate when enoxaparin sodium is dosed by anti-factor Xa (anti-Xa) trough level is not well described. Objective: To determine whether targeting a prophylactic anti-Xa trough level by adjusting the enoxaparin dose would reduce the VTE rate in trauma patients. Design, Setting, and Participants: Single-institution, historic vs prospective cohort comparison study at an urban, academic, level I trauma center...
November 1, 2016: JAMA Surgery
Bishwajit Bhattacharya, Adrian Maung, Kevin Schuster, Kimberly A Davis
BACKGROUND: Trauma centers are seeing an increasing number of geriatric patients that are more susceptible to injuries even from relatively minor insults such as a ground level fall (GLF). As life expectancy increases, people are living in the geriatric age bracket for decades and often use anticoagulation agents for various comorbidities. We hypothesize that this patient population is not homogenous and we investigated the injury patterns and outcomes after GLF as a function of age and anticoagulation use...
September 2016: Injury
Allison E Berndtson, Todd W Costantini, James Lane, Kevin Box, Raul Coimbra
BACKGROUND: Empiric enoxaparin dosing is inadequate for most trauma patients, leading to below target initial anti-Xa levels and requiring dose-adjustment for optimal venous thromboembolism (VTE) prophylaxis. We hypothesize that patient factors affecting initial anti-Xa levels can be identified based on drug pharmacokinetics, allowing creation of a new dosing protocol that will provide a higher percentage of in-target (0.2-0.4 IU/mL) patients at initial anti-Xa level assessment. METHODS: Records of 318 trauma patients were evaluated, and NONMEM and PSN software used to analyze 11 variables for their effects on anti-Xa levels...
May 27, 2016: Journal of Trauma and Acute Care Surgery
Scott A Chapman, Eric D Irwin, Patty Reicks, Gregory J Beilman
BACKGROUND: We report our experience dosing and monitoring enoxaparin with anti-factor Xa activity (anti-FXaA) levels for venous thromboembolism prophylaxis in trauma patients (TP). MATERIALS AND METHODS: TP receiving standard, non-weight-based dosed enoxaparin administered every 12 h for venous thromboembolism prophylaxis with peak anti-FXaA levels measured were prospectively monitored and evaluated and those whose first anti-FXaA levels ≥ or <0.2 IU/mL were compared...
March 2016: Journal of Surgical Research
O T Okoye, R Gelbard, K Inaba, M Esparza, H Belzberg, P Talving, P G Teixeira, L S Chan, D Demetriades
BACKGROUND: The use of low-molecular-weight heparin (LMWH) for the chemoprophylaxis of venous thromboembolism (VTE) in trauma patients is supported by Level-1 evidence. Because Enoxaparin was the agent used in the majority of studies for establishing the efficacy of LMWH in VTE, it remains unclear if Dalteparin provides an equivalent effect. OBJECTIVE: To compare Dalteparin to Enoxaparin and investigate their equivalence as VTE prophylaxis in trauma. PATIENTS/SETTING: Trauma patients receiving VTE chemoprophylaxis in the Surgical Intensive Care Unit of a Level-1 Trauma Center from 2009 (Enoxaparin) to 2010 (Dalteparin) were included...
April 2014: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Pranab Sinha, Ali-Asgar Najefi, John Hambidge
Neck of femur (NOF) fractures are a major public health concern because of the ageing population and higher incidence of fragility fractures. NOF fractures are associated with high mortality and morbidity rates, and there is a high risk of venous thromboembolism (VTE) after hip fractures (Ref 1). Therefore thromboprophylaxis is vital. Current NICE guidelines advocate 28 - 35 days of thromboprophylaxis after NOF fractures (Ref 1, 2). It came to our attention that patients post NOF fixation were getting variable prescriptions in regards to their thromboprophylaxis...
2014: BMJ Quality Improvement Reports
Emma Toman, Alastair Beaven, Moji Balogun, Keith Porter
A young mother presented to a major trauma centre following a road traffic collision. Her admission CT traumagram demonstrated liver and renal lacerations, spinal and pelvic fractures with no abnormalities of the ovarian veins. Her inpatient course was uncomplicated other than a sustained, isolated raised C reactive protein. CT of the abdomen 1 week after injury demonstrated stable solid organ injuries and the additional, unexpected finding of a right ovarian vein thrombosis (OVT). A pragmatic approach was taken towards the management of the OVT given the haemorrhagic risk from her traumatic injuries...
2015: BMJ Case Reports
Jack W Rostas, Sidney B Brevard, Naveed Ahmed, John Allen, Derek Thacker, William H Replogle, Richard P Gonzalez, Amin M Frotan, Jon D Simmons
Recent reports confirm that the standard dose of enoxaparin in obese patients is often subtherapeutic, leading to a higher incidence of venous thromboembolism. All patients receiving subcutaneous enoxaparin 30 mg twice a day (b.i.d.) for venous thromboembolism prophylaxis were prospectively enrolled in this study. Trough antiXa levels were obtained and any level less than 0.1 IU/mL was considered subtherapeutic and the final dosage requirement was recorded. Body mass index (BMI), abdominal wall thickness, and fluid balance were collected...
September 2015: American Surgeon
Erik J Olson, Jesse Bandle, Richard Y Calvo, Steven R Shackford, Casey E Dunne, Jan-Michael Van Gent, Ashley L Zander, Harminder Sikand, Michael S Bongiovanni, Michael J Sise, C Beth Sise
BACKGROUND: Research comparing enoxaparin with unfractionated heparin (UFH) given every 12 hours for venous thromboembolism (VTE) prophylaxis after trauma overlooks original recommendations that UFH be given every 8 hours. We conducted a prospective, randomized, noninferiority trial comparing UFH every 8 hours and standard enoxaparin every 12 hours. We hypothesized that the incidence of VTE in trauma patients receiving UFH every 8 hours would be no more than 10% higher than that in patients receiving enoxaparin every 12 hours...
December 2015: Journal of Trauma and Acute Care Surgery
Marion Wiegele, Dieter Adelmann, Johannes Gratz, Eva Schaden
INTRODUCTION: Administration of low molecular weight heparin (LMWH) is recommended for prophylaxis of venous thromboembolism in patients undergoing hip surgery. In this context, heparin-induced thrombocytopenia (HIT) type II is a complication of rare incidence but sometimes fatal outcome. CASE DESCRIPTION: A 52-year old obese patient undergoing antithrombotic therapy with Enoxaparin after hip surgery presented with a painful, swollen leg and thrombocytopenia on day eight after surgery...
2015: SpringerPlus
David A Machado-Aranda, Jill L Jakubus, Wendy L Wahl, Jill R Cherry-Bukowiec, Kathleen B To, Pauline K Park, Krishnan Raghavendran, Lena M Napolitano, Mark R Hemmila
BACKGROUND: The Michigan Trauma Quality Improvement Program (MTQIP) is a collaborative quality initiative sponsored by Blue Cross Blue Shield of Michigan and Blue Care Network (BCBSM/BCN). The MTQIP benchmark reports identified our trauma center as a high outlier for venous thromboembolism (VTE) episodes. This study outlines the performance improvement (PI) process used to reduce the rate of VTE using MTQIP infrastructure. STUDY DESIGN: Trauma patients admitted for > 24 hours, with an Injury Severity Score (ISS) ≥ 5, were included in this study...
September 2015: Journal of the American College of Surgeons
Jade M Nunez, Robert D Becher, Gerald J Rebo, Jason P Farrah, Erika M Borgerding, Joseph J Stirparo, Cynthia Lauer, Patrick Kilgo, Preston R Miller
Venous thromboembolism (VTE) is a leading cause of death in multisystem trauma patients; the importance of VTE prevention is well recognized. Presently, standard dose enoxaparin (30 mg BID) is used as chemical prophylaxis, regardless of weight or physiologic status. However, evidence suggests decreased bioavailability of enoxaparin in critically ill patients. Therefore, we hypothesized that a weight-based enoxaparin dosing regimen would provide more adequate prophylaxis (as indicated by antifactor Xa levels) for patients in our trauma intensive care unit (TICU)...
June 2015: American Surgeon
Christopher P Michetti, Elizabeth Franco, Jonathan Coleman, Anna Bradford, Amber W Trickey
BACKGROUND: Trauma patients requiring acute inpatient rehabilitation are significantly injured, with increased risk for deep vein thrombosis (DVT). We evaluated routine screening for occult DVT in such patients, and analyzed DVT risk factors. MATERIALS AND METHODS: Data from level I trauma center patients discharged to a single acute rehabilitation center (ARC) from 2007-2011 were retrospectively reviewed. Routine lower extremity duplex was performed on ARC admission...
December 2015: Journal of Surgical Research
Larissa A Martinez, Allison E Burnett
PURPOSE: The case of a patient with confirmed heparin-induced thrombocytopenia (HIT) and anticoagulation failure undergoing catheter-directed thrombolysis (CDT) with alteplase and bivalirudin for extensive thrombosis is reported. SUMMARY: A 48-year-old, morbidly obese Caucasian woman was admitted to a trauma-surgical intensive care unit (TSICU) after a motor vehicle accident. The patient suffered aortic and renal lacerations, multiple rib and spinal fractures, pleural effusion, bilateral subdural hematomas, and cerebral edema...
May 1, 2015: American Journal of Health-system Pharmacy: AJHP
Orly Lavan, Uri Rimon, Dani Simon, Boris Khaitovich, Batia Segal, Ehud Grossman, Yeroham Kleinbaum, David M Steinberg, Ophira Salomon
BACKGROUND: Venous thromboembolism (VTE) is a frequent complication of patients who experienced major trauma. Prevention of VTE is usually by thrombophylaxis and or by the use of a retrievable filter. Lately, the use of a retrievable filter in trauma patients has increased despite evidence cautioning against its use. AIMS: To evaluate complications related to a single type of filter prophylactically used in a tertiary trauma center and search for risk factors that may preclude filter retrieval METHODS: 142 patients aged 16 through 60 who experienced a major trauma and were treated with a prophylactic IVC filter of type optease were evaluated...
May 2015: Thrombosis Research
Mitchell J Daley, Sadia Ali, Carlos V R Brown
The objective of this study is to compare rates of venous thromboembolism (VTE) in patients who receive enoxaparin prophylaxis compared with no enoxaparin prophylaxis after craniotomy for traumatic brain injury (TBI). This retrospective cohort evaluated all trauma patients admitted to a Level I trauma center from January 2006 to December 2011 who received craniotomy after acute TBI. Patients were excluded if developed VTE before administration of enoxaparin or they died within the first 72 hours of hospital admission...
February 2015: American Surgeon
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