Decreasing VTE with Increased Lovenox Dosing in Trauma Patients

INTRODUCTION: Patients who suffer traumatic injuries are at increased risk of developing venous thromboembolism (VTE). The current standard prophylaxis is low molecular weight heparin, such as enoxaparin, administered at a dose of 30mg subcutaneously twice daily. The efficacy of this dosing has not been well established in patients with increased body mass index or increased abdominal wall density. OBJECTIVE: The primary objective of this paper was to analyze alternative dosing considerations based on certain patient populations. METHODS: This was a retrospective literature evaluation of data related to trauma patients, associated incidence of VTE, and alternative dosing strategies. RESULTS: The standard enoxaparin dosing of 30mg subcutaneously administered twice daily puts patients with elevated body mass index and total body weight at increased risk for subtherapeutic antiXa levels. CONCLUSION: Body mass index and total body weight affect the pharmacokinetics of enoxaparin. AntiXa measurements should be considered for these trauma patients to ensure proper VTE prophylaxis. The current standard dosing should be adjusted based on antiXa levels in specific patient populations