Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry
Introduction Optimal venous thromboembolism (VTE) enoxaparin prophylaxis dosing remains elusive. Weight-based (WB) dosing safely increases anti-factor Xa levels without the need for routine monitoring but it is unclear if it leads to lower VTE risk. We hypothesized that WB dosing would decrease VTE...
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BMJ Publishing Group
2024-07-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/9/1/e001230.full |
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| author | Sarah Lombardo Ram Nirula Elliott R Haut Scott Brakenridge Brandon Bruns Charles E Wade M Margaret Knudson Thomas Scalea Todd W Costantini Lisa Marie Knowlton David Spain Ernest E Moore Michelle K McNutt Matthew J Martin Andrew J Kerwin George C Velmahos Bruce Crookes Marta McCrum Lucy Kornblith Mark D Cipolle Laszlo N Kiraly David J Milia Alicia Mohr Frederick Rogers Sherry Sixta Jade Nunez |
| author_facet | Sarah Lombardo Ram Nirula Elliott R Haut Scott Brakenridge Brandon Bruns Charles E Wade M Margaret Knudson Thomas Scalea Todd W Costantini Lisa Marie Knowlton David Spain Ernest E Moore Michelle K McNutt Matthew J Martin Andrew J Kerwin George C Velmahos Bruce Crookes Marta McCrum Lucy Kornblith Mark D Cipolle Laszlo N Kiraly David J Milia Alicia Mohr Frederick Rogers Sherry Sixta Jade Nunez |
| author_sort | Sarah Lombardo |
| collection | DOAJ |
| description | Introduction Optimal venous thromboembolism (VTE) enoxaparin prophylaxis dosing remains elusive. Weight-based (WB) dosing safely increases anti-factor Xa levels without the need for routine monitoring but it is unclear if it leads to lower VTE risk. We hypothesized that WB dosing would decrease VTE risk compared with standard fixed dosing (SFD).Methods Patients from the prospective, observational CLOTT-1 registry receiving prophylactic enoxaparin (n=5539) were categorized as WB (0.45–0.55 mg/kg two times per day) or SFD (30 mg two times per day, 40 mg once a day). Multivariate logistic regression was used to generate a predicted probability of VTE for WB and SFD patients.Results Of 4360 patients analyzed, 1065 (24.4%) were WB and 3295 (75.6%) were SFD. WB patients were younger, female, more severely injured, and underwent major operation or major venous repair at a higher rate than individuals in the SFD group. Obesity was more common among the SFD group. Unadjusted VTE rates were comparable (WB 3.1% vs. SFD 3.9%; p=0.221). Early prophylaxis was associated with lower VTE rate (1.4% vs. 5.0%; p=0.001) and deep vein thrombosis (0.9% vs. 4.4%; p<0.001), but not pulmonary embolism (0.7% vs. 1.4%; p=0.259). After adjustment, VTE incidence did not differ by dosing strategy (adjusted OR (aOR) 0.75, 95% CI 0.38 to 1.48); however, early administration was associated with a significant reduction in VTE (aOR 0.47, 95% CI 0.30 to 0.74).Conclusion In young trauma patients, WB prophylaxis is not associated with reduced VTE rate when compared with SFD. The timing of the initiation of chemoprophylaxis may be more important than the dosing strategy. Further studies need to evaluate these findings across a wider age and comorbidity spectrum.Level of evidence Level IV, therapeutic/care management. |
| format | Article |
| id | doaj-art-443dc6eb294f4502a537ecd6ceae66dd |
| institution | Kabale University |
| issn | 2397-5776 |
| language | English |
| publishDate | 2024-07-01 |
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| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-443dc6eb294f4502a537ecd6ceae66dd2025-01-24T10:05:11ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762024-07-019110.1136/tsaco-2023-001230Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registrySarah Lombardo0Ram Nirula1Elliott R Haut2Scott Brakenridge3Brandon Bruns4Charles E Wade5M Margaret Knudson6Thomas Scalea7Todd W Costantini8Lisa Marie Knowlton9David Spain10Ernest E Moore11Michelle K McNutt12Matthew J Martin13Andrew J Kerwin14George C Velmahos15Bruce Crookes16Marta McCrum17Lucy Kornblith18Mark D Cipolle19Laszlo N Kiraly20David J Milia21Alicia Mohr22Frederick Rogers23Sherry Sixta24Jade Nunez25Surgery, University of Utah, Salt Lake City, Utah, USAUniversity of Utah School of Medicine, Salt Lake City, Utah, USADepartments of Surgery, Anesthesiology and Critical Care Medicine, and Emergency Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USADepartment of Surgery, University of Washington, Seattle, Washington, USADepartment of Surgery, UT Southwestern Medical School, Dallas, Texas, USASurgery, University of Texas Health Science Center at Houston, Houston, Texas, USASurgery, University of California San Francisco, San Francisco, California, USAUniversity of Maryland School of Medicine, Baltimore, Maryland, USADivision of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego Health, San Diego, California, USADepartment of Surgery, Stanford University, Stanford, California, USA2 Department of Surgery, Stanford University, Stanford, California, USADenver Health Medical Center, Denver, Colorado, USASurgery, University of Texas McGovern Medical School, Houston, Texas, USADivision of Trauma and Acute Care Surgery, Department of Surgery, Los Angeles General Medical Center, Los Angeles, California, USASurgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USAMassachusetts General Hospital, Boston, Massachusetts, USASurgery, Medical University of South Carolina, Charleston, South Carolina, USASurgery, University of Utah, Salt Lake City, Utah, USASurgery, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USALehigh Valley Health Network, Allentown, Pennsylvania, USAOregon Health & Science University, Portland, Oregon, USAMedical College of Wisconsin, Milwaukee, Wisconsin, USASurgery, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida, USALancaster General Health, Lancaster, Pennsylvania, USASt Anthony Hospital & Medical Campus, Lakewood, Colorado, USASurgery, University of Utah, Salt Lake City, Utah, USAIntroduction Optimal venous thromboembolism (VTE) enoxaparin prophylaxis dosing remains elusive. Weight-based (WB) dosing safely increases anti-factor Xa levels without the need for routine monitoring but it is unclear if it leads to lower VTE risk. We hypothesized that WB dosing would decrease VTE risk compared with standard fixed dosing (SFD).Methods Patients from the prospective, observational CLOTT-1 registry receiving prophylactic enoxaparin (n=5539) were categorized as WB (0.45–0.55 mg/kg two times per day) or SFD (30 mg two times per day, 40 mg once a day). Multivariate logistic regression was used to generate a predicted probability of VTE for WB and SFD patients.Results Of 4360 patients analyzed, 1065 (24.4%) were WB and 3295 (75.6%) were SFD. WB patients were younger, female, more severely injured, and underwent major operation or major venous repair at a higher rate than individuals in the SFD group. Obesity was more common among the SFD group. Unadjusted VTE rates were comparable (WB 3.1% vs. SFD 3.9%; p=0.221). Early prophylaxis was associated with lower VTE rate (1.4% vs. 5.0%; p=0.001) and deep vein thrombosis (0.9% vs. 4.4%; p<0.001), but not pulmonary embolism (0.7% vs. 1.4%; p=0.259). After adjustment, VTE incidence did not differ by dosing strategy (adjusted OR (aOR) 0.75, 95% CI 0.38 to 1.48); however, early administration was associated with a significant reduction in VTE (aOR 0.47, 95% CI 0.30 to 0.74).Conclusion In young trauma patients, WB prophylaxis is not associated with reduced VTE rate when compared with SFD. The timing of the initiation of chemoprophylaxis may be more important than the dosing strategy. Further studies need to evaluate these findings across a wider age and comorbidity spectrum.Level of evidence Level IV, therapeutic/care management.https://tsaco.bmj.com/content/9/1/e001230.full |
| spellingShingle | Sarah Lombardo Ram Nirula Elliott R Haut Scott Brakenridge Brandon Bruns Charles E Wade M Margaret Knudson Thomas Scalea Todd W Costantini Lisa Marie Knowlton David Spain Ernest E Moore Michelle K McNutt Matthew J Martin Andrew J Kerwin George C Velmahos Bruce Crookes Marta McCrum Lucy Kornblith Mark D Cipolle Laszlo N Kiraly David J Milia Alicia Mohr Frederick Rogers Sherry Sixta Jade Nunez Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry Trauma Surgery & Acute Care Open |
| title | Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry |
| title_full | Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry |
| title_fullStr | Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry |
| title_full_unstemmed | Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry |
| title_short | Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry |
| title_sort | weight based enoxaparin thromboprophylaxis in young trauma patients analysis of the clott 1 registry |
| url | https://tsaco.bmj.com/content/9/1/e001230.full |
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