Title: Optimal Dose of Enoxaparin in Critically Ill Trauma and Surgical Patients
Authors: Rutherford, Edmund J. MD; Schooler, Wesley G. MD; Sredzienski, Edward MS Pharm; Abrams, Jeffrey E. MD; Skeete, Dionne A. MD
Source: Journal of Trauma June 2005; 58(6):1167-70
PODIATRIC RELEVANCE:
There has been much discussion recently about DVT prophylaxis in foot and ankle surgery. While there is still no standard protocol for DVT prophylaxis, this article gives some insight as to the proper dosing of Lovenox (Enoxaparin) in the major trauma patient.
METHODS:
Prospective open label cohort study of eligible patients admitted to the surgical ICU at a single level one trauma center after major trauma or critical illness. Patients received a standard regimen of 40 mg of Enoxaparin by subcutaneous injection daily. All patients had blood samples drawn four hours after administration of the third dose of Enoxaparin to obtain the peak activity and just before the fourth dose to obtain the trough. Samples were analyzed using an Enoxaparin-specific anti-Xa assay. Anti-Xa activity was recorded in international units per milliliter. The recommended target range is 0.1 to 0.2 International Units/mL.
RESULTS:
Seventeen patients comprised the study group. The mean peak anti-Xa activity was 0.19 ± 0.09 International Units/mL, while the mean trough was 0.04 ± 0.04 International Units/mL (recommended target range of 0.1–0.2 International Units/mL). Five patients had a trough of zero after the third dose of Enoxaparin. The trough was below therapeutic levels in all but two patients. One thrombosis occurred in a patient despite a therapeutic trough. There were no adverse bleeding complications, episodes of significant thrombocytopenia or heparin-induced thrombocytopenia (HIT) syndrome.
COMMENTS:
According to this article, daily dosing of Enoxaparin is inadequate for critically ill and major trauma patients. While the foot and ankle surgeon may see a limited number of critically ill trauma patients, it does pose questions about Lovenox dosing in patients sustaining major foot and ankle trauma. It seems further studies are needed, specifically for lower extremity trauma, on Lovenox dosing and DVT prophylaxis in general.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.