Characterizing the delays in adequate thromboprophylaxis after TBI

Area of Science:

• Pharmacology
• Trauma Surgery
• Critical Care Medicine

Background:

• Venous thromboembolism (VTE) prophylaxis is crucial in trauma patients.
• Traumatic brain injury (TBI) may impact the efficacy of standard enoxaparin dosing.
• Current enoxaparin dosing protocols may not adequately address VTE prophylaxis in TBI patients.

Purpose of the Study:

• To compare enoxaparin dosing for VTE prophylaxis in trauma patients with and without TBI.
• To determine the time and dose required to achieve target anti-Xa levels in these cohorts.
• To investigate potential delays and dose adjustments needed for TBI patients.

Main Methods:

• Retrospective review of trauma patients receiving enoxaparin with anti-Xa level monitoring (August 2014 - October 2016).
• Inclusion criteria: patients achieving target anti-Xa trough levels (0.1-0.2 IU/mL).
• Comparison of enoxaparin initiation time, dose, anti-Xa levels, and VTE rates between TBI and non-TBI groups.

Main Results:

• Patients with TBI (25.2%) experienced significantly longer delays in enoxaparin initiation (7.5 vs. 1.5 days) and reaching target anti-Xa levels (11 vs. 5 days).
• Higher rates of unfractionated heparin use (46.3% vs. 11.5%) and VTE (22.0% vs. 9.0%) were observed in the TBI group.
• The median enoxaparin dose required to reach target levels was 40 mg BID for both groups.

Conclusions:

• Trauma patients with TBI require a median of 11 days to reach target anti-Xa levels with enoxaparin 40 mg BID.
• Delayed prophylaxis and increased unfractionated heparin use in TBI patients likely contribute to higher VTE rates.
• Current enoxaparin dosing strategies may need adjustment for TBI patients to optimize VTE prophylaxis.