Christopher J Pannucci1, Ann Marie Prazak2, Melody Scheefer3. 1. Division of Plastic Surgery, Division of Health Services Research, University of Utah, Salt Lake City, UT, USA. Electronic address: Christopher.Pannucci@hsc.utah.edu. 2. Department of Pharmacy Services, University of Utah, Salt Lake City, UT, USA. 3. Division of Plastic Surgery, University of Utah, Salt Lake City, UT, USA.
Abstract
BACKGROUND: Between 2% and 10% of the highest risk surgery, patients have a "breakthrough" venous thromboembolism (VTE) event despite receipt of chemoprophylaxis. The goals of this review are to summarize how patient-level factors may predict enoxaparin metabolism and how alterations in enoxaparin dose magnitude and frequency affect both anti-factor Xa (aFXa) levels and downstream VTE events. DATA SOURCES: Relevant articles were identified on PubMed. Fixed-dose prophylaxis provides inadequate enoxaparin prophylaxis for most surgical patients based on anti-factor Xa levels. Inadequate enoxaparin dosing has been correlated with both asymptomatic and symptomatic VTE events. Patient-level factors such as gross weight and extent of injury predict enoxaparin metabolism. Weight-based or weight-tiered dosing regimens-and real-time dose adjustment based on anti-factor Xa levels-allow an increased proportion of patients to have in-range anti-factor Xa levels. CONCLUSIONS: Inadequate enoxaparin dosing may explain why some patients have VTE despite enoxaparin prophylaxis. Ongoing research in the utility of weight-based or anti-factor Xa level driven enoxaparin dosing and dose adjustment is reasonable.
BACKGROUND: Between 2% and 10% of the highest risk surgery, patients have a "breakthrough" venous thromboembolism (VTE) event despite receipt of chemoprophylaxis. The goals of this review are to summarize how patient-level factors may predict enoxaparin metabolism and how alterations in enoxaparin dose magnitude and frequency affect both anti-factor Xa (aFXa) levels and downstream VTE events. DATA SOURCES: Relevant articles were identified on PubMed. Fixed-dose prophylaxis provides inadequate enoxaparin prophylaxis for most surgical patients based on anti-factor Xa levels. Inadequate enoxaparin dosing has been correlated with both asymptomatic and symptomatic VTE events. Patient-level factors such as gross weight and extent of injury predict enoxaparin metabolism. Weight-based or weight-tiered dosing regimens-and real-time dose adjustment based on anti-factor Xa levels-allow an increased proportion of patients to have in-range anti-factor Xa levels. CONCLUSIONS: Inadequate enoxaparin dosing may explain why some patients have VTE despite enoxaparin prophylaxis. Ongoing research in the utility of weight-based or anti-factor Xa level driven enoxaparin dosing and dose adjustment is reasonable.
Authors: Christopher J Pannucci; Kory I Fleming; Corinne B Bertolaccini; Ann Marie Prazak; Lyen C Huang; T Bartley Pickron Journal: JAMA Surg Date: 2019-08-01 Impact factor: 14.766
Authors: Christopher J Pannucci; Kory I Fleming; Thomas K Varghese; John Stringham; Lyen C Huang; T Bartley Pickron; Ann Marie Prazak; Corinne Bertolaccini; Arash Momeni Journal: Ann Surg Date: 2020-10-19 Impact factor: 12.969