Enoxaparin Titration for Venous Thromboembolism Prophylaxis in the Burn-Injured Patient-A Single Center Experience

Burn-injured patients develop altered metabolic processes, predisposing them to venous thromboembolism and bleeding. Enoxaparin titration for venous thromboembolism prevention in trauma patients is safe, but this approach is not well-defined in burn-injured patients. We hypothesized that titration of enoxaparin in burn patients is safe and does not increase bleeding risk. We compared a fixed dose 30 mg twice-daily enoxaparin dosing regimen to anti-Xa guided, twice-daily enoxaparin titration. Trough anti-Xa levels were measured and adjusted by 10 mg intervals, with repeat anti-Xa levels measured prior to administration of the fourth or fifth dose. The starting dose in the titrated group was determined by injury type, patient characteristics, and renal clearance as per American Association of Surgeons in Trauma guidelines. One hundred and fifty-two patients were included. Ninety-three received fixed dosing, and 59 were titrated by anti-Xa levels. There were 16 total incidents of bleeding but no difference between the two groups (P = .67). Univariate analysis revealed no differences in patient demographics or comorbidities between those with and without bleeding. When comparing dosing trends, 14 of 20 patients (70%) initiated at 30 mg were at goal anti-Xa level on initial check, while 5 (25%) were subtherapeutic, and 1 (5%) was supratherapeutic. Comparatively, 24 of 39 patients (62%) started at 40 mg were at goal anti-Xa level on initial check, while 9 (23%) were subtherapeutic and 6 (15%) were supratherapeutic. We observed that enoxaparin titration does not significantly increase bleeding risk. Larger studies are needed to confirm these findings and determine their effect on venous thromboembolism prevention.