Standard medication regimen, routine anti-Xa level monitoring, and dose adjustment in obesity
| Question response | Total cohort (n=118) | Academic institution (n=94) | Non-academic institution (n=24) | P value | Clinical pharmacist on trauma team (n=76) | No clinical pharmacist (n=42) | P value | Level I trauma designation (n=100) | Level II/III trauma designation (n=18) | P value | Protocol for VTE prophylaxis (n=103) | No protocol (n=15) | P value |
| Guideline-directed regimen, n (%) | 96 (81.4) | 81 (86.2) | 15 (62.5) | 0.0158 | 67 (88.2) | 29 (69.0) | 0.0142 | 83 (83.0) | 13 (72.2) | 0.3246 | 84 (81.6) | 12 (80.0) | 1 |
| Standard regimen*, n (%) | |||||||||||||
| Enoxaparin 40 mg subcutaneously every 24 hours | 14 (11.9) | 6 (6.4) | 8 (33.3) | 6 (7.9) | 8 (19.0) | 11 (11.0) | 3 (16.7) | 12 (11.7) | 2 (13.3) | ||||
| Enoxaparin 30 mg subcutaneously every 12 hours | 80 (67.8) | 68 (72.3) | 12 (50.0) | 55 (72.4) | 25 (59.5) | 71 (71.0) | 9 (50.0) | 70 (68.0) | 10 (66.7) | ||||
| Enoxaparin 40 mg subcutaneously every 12 hours | 8 (6.8) | 7 (6.4) | 1 (4.2) | 5 (6.6) | 3 (7.1) | 5 (5.0) | 3 (16.7) | 6 (5.8) | 2 (13.3) | ||||
| Enoxaparin 0.5 mg/kg subcutaneously every 12 hours | 8 (6.8) | 6 (6.4) | 2 (8.3) | 7 (9.2) | 1 (2.4) | 7 (7.0) | 1 (5.6) | 8 (7.8) | 0 (0.0) | ||||
| UFH 5000 units subcutaneously every 8 hours | 2 (1.7) | 2 (2.1) | 0 (0.0) | 1 (1.3) | 1 (2.4) | 1 (1.0) | 1 (5.6) | 1 (1.0) | 1 (6.7) | ||||
| Other | 6 (5.1) | 5 (5.3) | 1 (4.2) | 2 (2.6) | 4 (9.5) | 5 (5.0) | 1 (5.6) | 6 (5.8) | 0 (0.0) | ||||
| Standard regimen in renal dysfunction†, n (%) | |||||||||||||
| Enoxaparin 40 mg subcutaneously every 24 hours | 9 (7.6) | 5 (5.3) | 4 (16.7) | 5 (6.6) | 4 (9.5) | 7 (7.0) | 2 (11.1) | 8 (7.8) | 1 (6.7) | ||||
| Enoxaparin 30 mg subcutaneously every 12 hours | 11 (9.3) | 8 (8.5) | 3 (12.5) | 7 (9.2) | 4 (9.5) | 9 (9.0) | 2 (11.1) | 10 (9.7) | 1 (6.7) | ||||
| Enoxaparin 40 mg subcutaneously every 12 hours | 3 (2.5) | 3 (3.2) | 0 (0.0) | 2 (2.6) | 1 (2.4) | 2 (2.0) | 1 (5.6) | 2 (1.9) | 1 (6.7) | ||||
| Enoxaparin 0.5 mg/kg subcutaneously every 12 hours | 3 (2.5) | 2 (2.1) | 1 (4.2) | 2 (2.6) | 1 (2.4) | 3 (3.0) | 0 (0.0) | 3 (2.9) | 0 (0.0) | ||||
| Enoxaparin 30 mg subcutaneously every 24 hours | 6 (5.1) | 5 (5.3) | 1 (4.2) | 4 (5.3) | 2 (4.8) | 4 (4.0) | 2 (11.1) | 6 (5.8) | 0 (0.0) | ||||
| UFH 5000 units subcutaneously every 8 hours | 72 (61.0) | 58 (61.7) | 14 (58.3) | 48 (63.2) | 24 (57.1) | 62 (62.0) | 10 (55.6) | 60 (58.3) | 12 (80.0) | ||||
| UFH 5000 units subcutaneously every 12 hours | 9 (7.6) | 8 (8.5) | 1 (4.2) | 5 (6.6) | 4 (9.5) | 8 (8.0) | 1 (5.6) | 9 (8.7) | 0 (0.0) | ||||
| Other | 5 (4.2) | 5 (5.3) | 0 (0.0) | 3 (3.9) | 2 (4.8) | 5 (5.0) | 0 (0.0) | 5 (4.9) | 0 (0.0) | ||||
| Routinely dose adjust enoxaparin in overweight or obese, n (%) | 88 (74.6) | 75 (79.8) | 13 (54.2) | 0.0168 | 62 (81.6) | 26 (61.9) | 0.0268 | 78 (78.0) | 10 (55.6) | 0.0736 | 79 (76.7) | 9 (60.0) | 0.2048 |
| Routinely monitor anti-Xa levels, n (%) | |||||||||||||
| Yes | 78 (66.1) | 62 (66.0) | 16 (66.7) | 0.5798 | 46 (60.5) | 32 (76.2) | 0.0688 | 64 (64.0) | 14 (77.8) | 0.2254 | 65 (63.1) | 13 (86.7) | 0.3464 |
| No | 29 (24.6) | 25 (26.6) | 4 (16.7) | 23 (30.3) | 6 (14.3) | 27 (27.0) | 2 (11.1) | 27 (26.2) | 2 (13.3) | ||||
| No response | 11 (9.3) | 7 (7.4) | 4 (16.7) | 7 (9.2) | 4 (9.5) | 9 (9.0) | 2 (11.1) | 11 (10.7) | 0 (0.0) | ||||
*Non-obese (body mass index <30) and normal renal function (creatinine clearance ≥30 mL/min).
†Creatinine clearance ≤30 mL/min.
Anti-Xa, antifactor Xa; UFH, unfractionated heparin; VTE, venous thromboembolism.