2025 Southeastern Residency Conference

Title: Evaluation of Pharmacist-Driven Enoxaparin Dosing Using Anti-Xa Monitoring in Obese Trauma Patients


Authors: Kathleen White, Jacquelyn Crawford, Cameron Lanier, Austin Roe, Jess Brumit, Jen Tharp, Vera Wilson


Background: Obesity and trauma are both independent risk factors for the development of venous thromboembolism (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE). Enoxaparin (in the setting of adequate renal function) is the preferred agent for VTE prophylaxis in trauma patients by the Eastern Association for the Surgery of Trauma, Western Trauma Association, and American Association for Surgery of Trauma/ American College of Surgeons Comittee. Recent studies have suggested that weight-based dosing strategies may result in prophylactic concentrations more reliably than fixed dosing and that pharmacist-driven protocols are effective in adjusting enoxaparin based on levels to maintain prophylactic efficacy. While an association between higher BMI and subprophylactic enoxaparin dosing has been identified, data is still lacking to describe the prevalence and impact of weight-based dosing in obese trauma patients. Given increasing national trends in obesity and higher rates of obesity in the Appalachian region compared to the national average, we sought to evaluate the efficacy of this protocol in our population presenting to the Level 1 Trauma Center of the region.


Methods: This was a retrospective study conducted via chart review of adult (aged greater than or equal to 18) trauma patients presenting to Johnson City Medical Center in Johnson City, TN between October 1st, 2022 and May 1st, 2024. Patients were included if they met criteria for the weight-based protocol (trauma without traumatic brain injury or spinal cord injury, CrCl 30 mL/min and above, and weight of 50 kg or more), had received 2-3 consecutive doses of enoxaparin, and had at least one Xa level for evaluation. Patients were excluded if they did not meet the above criteria, were not on the protocol, pregnant, incarcerated, or reported therapeutic anticoagulation prior to hospital admission. The primary outcome is efficacy (frequency) of the protocol in achieving prophylactic Xa levels. Additional outcomes collected wil be incidence of VTE, incidence of International Society of Thrombosis and Hemostasis (ISTH) major bleeding, bleeding requiring blood product transfusion, length of ICU/ hospital stay, and mortality. Data will be analyzed using univariate and multivariate analysis as indicated. 


Results: In Progress


Conclusion: In Progress