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Enoxaparin and Trauma

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https://www.readbyqxmd.com/read/29071333/association-of-anti-factor-xa-guided-dosing-of-enoxaparin-with-venous-thromboembolism-after-trauma
#1
Charles A Karcutskie, Arjuna Dharmaraja, Jaimin Patel, Sarah A Eidelson, Anish B Padiadpu, Arch G Martin, Gabriel Lama, Edward B Lineen, Nicholas Namias, Carl I Schulman, Kenneth G Proctor
Importance: The efficacy of anti-factor Xa (anti-Xa)-guided dosing of thromboprophylaxis after trauma remains controversial. Objective: To assess whether dosing of enoxaparin sodium based on peak anti-Xa levels is associated with the venous thromboembolism (VTE) rate after trauma. Design, Setting, and Participants: Retrospective review of 950 consecutive adults admitted to a single level I trauma intensive care unit for more than 48 hours from December 1, 2014, through March 31, 2017...
October 25, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28863205/bruises-on-the-ears-and-body
#2
Diana M Sarmiento, Thomas F Northrup, Yu Wah
Over the course of a month, this 34-year-old woman had sought care at our facility--and another--on 3 separate occasions for painful bruises (visits #1 and #3) and deep vein thrombosis (visit #2). The bruises first appeared acutely on her arms, prompting her first visit to our ED and leading to a hospital stay. Several weeks later, the patient developed new bruise-like lesions on her earlobes, face, trunk, and lower extremities. In between these 2 visits, the patient was seen in another ED (and admitted) for right upper extremity DVT and was started on enoxaparin, followed by warfarin...
September 2017: Journal of Family Practice
https://www.readbyqxmd.com/read/28697017/risk-factors-for-deep-vein-thrombosis-and-pulmonary-embolism-after-traumatic-injury-a-competing-risks-analysis
#3
Jan-Michael Van Gent, Richard Y Calvo, Ashley L Zander, Erik J Olson, C Beth Sise, Michael J Sise, Steven R Shackford
BACKGROUND: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is typically reported as a composite measure of the quality of trauma center care. Given recent data suggesting post-injury DVT and PE are distinct clinical processes, a better understanding may result from analyzing them as independent, competing events. Using competing risks analysis, we evaluated our hypothesis that the risk factors and timing of post-injury DVT and PE are different...
July 8, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28475282/risk-of-intracranial-hemorrhage-in-ground-level-fall-with-antiplatelet-or-anticoagulant-agents
#4
Michael Ganetsky, Gregory Lopez, Tara Coreanu, Victor Novack, Steven Horng, Nathan I Shapiro, Kenneth A Bauer
OBJECTIVES: Anticoagulant and antiplatelet medications are known to increase the risk and severity of traumatic intracranial hemorrhage (tICH), even with minor head trauma. Most studies on bleeding propensity with head trauma are retrospective, are based on trauma registries, or include heterogeneous mechanisms of injury. The goal of this study was to determine the rate of tICH from only a common low-acuity mechanism of injury, that of a ground-level fall, in patients taking one or more of the following antiplatelet or anticoagulant medications: aspirin, warfarin, prasugrel, ticagrelor, dabigatran, rivaroxaban, apixaban, or enoxaparin...
October 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28465988/thrombotic-risk-after-a-major-bleeding-during-anticoagulation-a-clinical-case
#5
Serenella Conti, Marco Ciuffetti, Maria Cristina Vedovati
We report on a 81-year-old female admitted to the emergency department for the occurrence of abdominal pain after a minor trauma. She was on treatment with warfarin for atrial fibrillation. The abdominal computed tomography (CT) angiography revealed a retroperitoneal hematoma (RH) of the left iliopsoas muscle with no evidence of active bleeding. The international normalized ratio exceeded the upper recommended anticoagulation limit. Prothrombin complex concentrates (PCCs) were used for anticoagulation reversal...
January 2017: Journal of Cardiovascular Echography
https://www.readbyqxmd.com/read/28228055/increased-enoxaparin-dosing-for-venous-thromboembolism-prophylaxis-in-general-trauma-patients
#6
REVIEW
Cheri K Walker, Elizabeth A Sandmann, Taylor J Horyna, Mark A Gales
OBJECTIVE: To review the evidence regarding increased enoxaparin dosing for venous thromboembolism (VTE) prophylaxis in the general trauma patient population. DATA SOURCES: 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. STUDY SELECTION AND DATA EXTRACTION: Search results were limited to English-language studies conducted in humans...
April 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28205078/enoxaparin-dose-reduction-for-thrombocytopenia-in-patients-with-cancer-a-quality-assessment-study
#7
Simon Mantha, Yimei Miao, Jonathan Wills, Rekha Parameswaran, Gerald A Soff
The development of thrombocytopenia in the setting of therapeutic anticoagulation for venous thromboembolic disease (VTE) is common in cancer patients, but guidelines for management are based on limited past data and have not been validated. In 2011, Memorial Sloan Kettering Cancer Center (MSKCC) implemented the following guidelines in this setting: administer full dose enoxaparin for a platelet count > 50,000/mcL, half-dose enoxaparin for a platelet count of 25,000-50,000/mcL, and hold anticoagulation for a platelet count < 25,000/mcL...
May 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28108019/goal-directed-enoxaparin-dosing-provides-superior-chemoprophylaxis-against-deep-vein-thrombosis
#8
Tammy R Kopelman, Jarvis W Walters, James N Bogert, Usmaan Basharat, Paola G Pieri, Karole M Davis, Asia N Quan, Sydney J Vail, Melissa A Pressman
INTRODUCTION: 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. MATERIALS AND METHODS: Retrospective review of trauma patients having received prophylactic enoxaparin and appropriately timed anti-Xa levels was performed...
May 2017: Injury
https://www.readbyqxmd.com/read/28031644/ineffective-treatment-of-low-molecular-weight-heparin-in-obese-subject-with-traumatic-fractures-of-the-leg
#9
Egidio Imbalzano, Michele Creazzo, Giovanni Trapani, Giuseppina Lizio, Antonino Saitta
American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 9th edition, 2012, suggest no prophylaxis rather than pharmacological thromboprophylaxis in management of venous thromboembolism (VTE) risk of isolated lower leg injuries distal to knee requiring leg immobilization. Low-molecular-weight heparin (LMWH) is a class of drugs commonly used as antithrombotics in surgery and in case of prolonged bed rest and hypomobility. A 35-year-old obese man with no history of health disease (height, 170 cm; weight, 95 kg; and body mass index, 32...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/27889266/the-effect-anticoagulation-status-on-geriatric-fall-trauma-patients
#10
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 < ...
December 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27633687/an-analysis-of-deep-vein-thrombosis-in-burn-patients-part-ii-a-randomized-and-controlled-study-of-thrombo-prophylaxis-with-low-molecular-weight-heparin
#11
RANDOMIZED CONTROLLED TRIAL
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...
December 2016: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/27488490/anti-xa-guided-enoxaparin-thromboprophylaxis-reduces-rate-of-deep-venous-thromboembolism-in-high-risk-trauma-patients
#12
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 (TPX) protocol on the incidence of VTE in high-risk trauma patients based on Greenfield's Risk Assessment Profile (RAP) score. METHODS: This is a retrospective observational study of patients admitted to a trauma intensive care unit over a 12-month period. Patients were included if they received anti-Xa-guided enoxaparin TPX...
December 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27487253/thrombelastography-based-dosing-of-enoxaparin-for-thromboprophylaxis-in-trauma-and-surgical-patients-a-randomized-clinical-trial
#13
RANDOMIZED CONTROLLED TRIAL
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...
October 19, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27383732/association-between-enoxaparin-dosage-adjusted-by-anti-factor-xa-trough-level-and-clinically-evident-venous-thromboembolism-after-trauma
#14
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
https://www.readbyqxmd.com/read/27346422/the-older-they-are-the-harder-they-fall-injury-patterns-and-outcomes-by-age-after-ground-level-falls
#15
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
https://www.readbyqxmd.com/read/27244575/if-some-is-good-more-is-better-an-enoxaparin-dosing-strategy-to-improve-pharmacologic-venous-thromboembolism-prophylaxis
#16
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 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 were used to analyze 11 variables for their effects on anti-Xa levels...
December 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/26850200/non-weight-based-enoxaparin-dosing-subtherapeutic-in-trauma-patients
#17
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
https://www.readbyqxmd.com/read/26815899/dalteparin-versus-enoxaparin-for-the-prevention-of-venous-thromboembolic-events-in-trauma-patients
#18
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
https://www.readbyqxmd.com/read/26734300/a-simple-measure-to-improve-the-rates-of-thromboprophylaxis-prescription-post-surgical-fixation-of-neck-of-femur-fractures-in-a-district-general-hospital
#19
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
https://www.readbyqxmd.com/read/26682843/ovarian-vein-thrombosis-in-a-polytrauma-patient
#20
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
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