Effect of a dalteparin prophylaxis protocol using anti-factor Xa concentrations on venous thromboembolism in high-risk trauma patients

Abstract

Therapeutic study, level IV.

Plasma anti-FXa level as a surrogate marker of the adequacy of thromboprophylaxis in critically ill patients: A systematic review

“…Moreover, if the median anti-FXa level was below b0.1 IU/mL at 12 h, the rates of VTE (14.4% vs. 5.4%, p = 0.05) and DVT (14.4%. vs. 3.2% p = 0.01) were significantly higher [28].…”

“…Trial characteristics are presented in Table 1. Most of these studies (10 observational studies and two RCTs) tested the effects of different dosages of enoxaparin [15][16][17][18][19][20][21][22][23][24][25][26], whereas four observational studies assessed dalteparin [27][28][29][30], and one each tested certoparin [31] and nadroparin [32]. No studies testing tinzaparin were identified.…”

“…Administration of a standard prophylactic dosage of LMWH to obese ICU patients results in lower anti-FXa activity than in non-obese individuals [28,20]. However, enoxaparin dose may be positively correlated with anti-FXa levels, with adequate peak anti-FXa levels achieved using a weight-adjusted dose of enoxaparin (1 mg/kg once daily) [23].…”

Association Between Enoxaparin Dosage Adjusted by Anti–Factor Xa Trough Level and Clinically Evident Venous Thromboembolism After Trauma

“…Rather than monitoring peak levels, we chose to adjust the enoxaparin dosage to target anti-Xa trough levels, as some studies suggest that troughs may better correlate with rates of DVT after trauma. 12,23 One prospective study of 54 critically ill surgical and trauma patients demonstrated that standard prophylactic dosages of enoxaparin sodium, 30 mg twice daily, often resulted in low anti-Xa levels and higher rates of DVT. 12 The investigators found that 27 of the patients (50%) had low trough levels (≤0.1 IU/mL) and 37% of those with subprophylactic levels had DVTs, while 11% of those with adequate levels had DVTs.…”

The Poor Effectiveness and Safety of the Standard Algorithm for the Prevention of Postoperative Venous Thromboembolism Attributable to the Individual Reaction of the Hemostatic System

“…В качестве метода контроля адекватности применения НМГ предлагают опреде-лять анти-Ха-активность плазмы крови. В частно-сти, существуют публикации о необходимости кор-рекции дозы НМГ в соответствии с уровнем этого показателя для повышения эффективности профи-лактики ВТЭО у больных из группы высокого и чрезвычайно высокого риска [11][12][13]. В то же время данный тест не является рутинным для клиниче-ской практики и находит ограниченное примене-ние.…”