Venous Thromboembolism Rates in Trauma Patients Significantly Increase With Missed Prophylactic Enoxaparin Doses.

Area of Science:

• Trauma surgery
• Pharmacology
• Thromboembolism prevention

Background:

• Prophylactic enoxaparin effectively reduces venous thromboembolism (VTE) without substantially increasing bleeding risk.
• Despite evidence, enoxaparin prophylaxis is often withheld for surgical procedures in trauma patients.
• This study quantifies the VTE risk associated with missed enoxaparin doses in trauma care.

Purpose of the Study:

• To determine the association between missed prophylactic enoxaparin doses and the incidence of VTE in trauma patients.
• To explore the specific risks of VTE when enoxaparin prophylaxis is interrupted.
• To inform clinical practice regarding enoxaparin use in trauma patients undergoing procedures.

Main Methods:

• Retrospective cohort study of trauma patients from January 2012 to January 2021 at a Level 1 trauma center.
• 1:1 propensity score matching with ten variables to compare VTE and no-VTE groups.
• Primary outcome was the occurrence of a VTE event.

Main Results:

• A cohort of 184 patients (493 initially screened) was analyzed after propensity matching.
• Patients who experienced a VTE had a higher incidence of missed prophylactic enoxaparin doses (34.8% vs. 21.7%, P=0.049).
• Missing at least one dose of enoxaparin nearly doubled the odds of VTE (OR 1.92).

Conclusions:

• Interruption of prophylactic enoxaparin significantly elevates VTE risk in trauma patients.
• Enoxaparin doses were predominantly withheld for procedures, not due to bleeding complications.
• Clinical decisions to withhold enoxaparin should carefully consider the substantial thromboembolic risk versus potential bleeding risk.