Background: Trauma patients admitted to the intensive care unit (ICU) are at a high risk of developing venous thromboembolism (VTE). VTE prophylaxis for these patients remains variable in clinical practice. Enoxaparin is commonly used for VTE prophylaxis, although dosing regimens can be fixed, stratified, or weight-based, without definitive evidence for optimal dosing strategy.
Objective: This study assessed the effectiveness of the current practice of chemical VTE prophylaxis in trauma patients at The Canberra Hospital.
Methods: A prospective review was performed on patients admitted under the ACT Trauma Service from July 2022 to November 2022, including patients over 18 years of age who received at least 3 doses of enoxaparin for VTE prophylaxis. Anti-Factor Xa (aFXa), assessed after 3 doses of enoxaparin, was used as the marker for enoxaparin activity.
Results: Daily dosing of 40 mg was used in 92% of patients. The average BMI was 27. Only weight was associated with a statistically significant difference in aFXa levels.
Discussion: Approximately one in four trauma patients in ICU had subtherapeutic VTE prophylaxis, as measured by aFXa levels. Higher weight was significantly correlated with inadequate VTE prophylaxis dosing. Whilst age, sex and smoking status might play important role in clinical decision making, they did not significantly correlate with prophylaxis adequacy in the study population.
Conclusion: The majority of trauma patients in the ACT received fixed dosing of enoxaparin VTE prophylaxis. Higher body weight was associated with subtherapeutic aFXa levels. Weight-based dosing of enoxaparin may be more effective in achieving adequate VTE prophylaxis.