American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma Clinical Protocol for inpatient venous thromboembolism prophylaxis after trauma

Yorkgitis, Brian K.; Berndtson, Allison E.; Cross, Alisa; Kennedy, Ryan David; Kochuba, Matthew; Tignanelli, Christopher J.; Tominaga, Gail T.; Jacobs, David; Marx, William H; Ashley, Dennis W.; Ley, Eric J.; Napolitano, Lena M.; Costantini, Todd W.

doi:10.1097/ta.0000000000003475

Cited by 54 publications

(92 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Protocols for VTE prophylaxis remain imperfect in achieving adequate anticoagulation in patients with traumatic injury. Current guidelines agree that LMWH is superior to unfractionated heparin; 5,7,8,22 however, debate exists regarding what factors significantly influence anti-Xa response to enoxaparin. To our knowledge, this is the largest single-institution examination of VTE prophylaxis with enoxaparin to find sex to be a determinant of anti-Xa response when controlling for factors of established significance such as patient weight and renal function.…”

Section: Discussionmentioning

confidence: 99%

One size does not fit all: Sex bias in pharmacologic venous thromboembolism prophylaxis

Modi

Borst

Kirchberg

et al. 2022

J Trauma Acute Care Surg

Self Cite

View full text Add to dashboard Cite

BACKGROUND:The optimal enoxaparin dosing strategy to achieve venous thromboembolism (VTE) prophylaxis in trauma patients remains unclear.Current dosing guidelines often include weight, age, and renal function but still fail to achieve appropriate prophylactic anti-Xa levels in many patients. We hypothesized that additional patient factors influence anti-Xa response to enoxaparin in trauma patients. METHODS:This is a retrospective review of patients admitted to a Level 1 trauma center for ≥4 days from July 2015 to September 2020, who received enoxaparin VTE prophylaxis per protocol (50-59 kg, 30 mg/dose; 60-99 kg, 40 mg/dose; ≥100 kg, 50 mg/dose; all doses every 12 hours) and had an appropriately timed peak anti-Xa level. Multivariate regression was performed to identify independent predictors of prophylactic anti-Xa levels (0.2-0.4 IU/mL) upon first measurement. RESULTS:The cohort (N = 1,435) was 76.4% male, with a mean ± SD age of 49.9 ± 20.0 years and a mean ± SD weight of 82.5 ± 20.2 kg (males, 85.2 kg; females, 73.7 kg; p <0.001). Overall, 68.6% of patients (n = 984) had a prophylactic anti-Xa level on first assessment (69.6% of males, 65.1% of females). Males were more likely to have a subprophylactic level than females (22.1% vs. 8.0%, p <0.001), whereas females were more likely to have supraprophylactic levels than males (26.9% vs. 8.3%, p < 0.001). When controlling for creatinine clearance, anti-Xa level was independently associated with dose-to-weight ratio (odds ratio, 0.191 for 0.5 mg/kg; p < 0.001; confidence interval, 0.151-0.230) and female sex (odds ratio, 0.060; p < 0.001; confidence interval, 0.047-0.072). Weight and age were not significant when controlling for the other factors. CONCLUSION:Male patients have a decreased anti-Xa response to enoxaparin when compared with female patients, leading to a greater incidence of subprophylactic anti-Xa levels in male patients at all dose-to-weight ratios. To improve the accuracy of VTE chemoprophylaxis, sex should be considered as a variable in enoxaparin dosing models.

show abstract

Section: Discussionmentioning

confidence: 99%

One size does not fit all: Sex bias in pharmacologic venous thromboembolism prophylaxis

Modi

Borst

Kirchberg

et al. 2022

J Trauma Acute Care Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“… 27 This updated guideline is based off the recommendations from the American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma Clinical Protocol. 29 …”

Section: Discussionmentioning

confidence: 99%

“… Fully ambulatory patients with expected LOS less than 24 hours do not require chemoprophylaxis For patients with associated traumatic brain injuries, please refer to the modified Berne-Norwood criteria. 29 For patients with active bleeding, only mechanical prophylaxis is recommended. BDI, twice per day; BMI, body mass index; CrCl, creatinine clearance; LOS, length of stay.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

National Trends in Venous Thromboembolism in the Adult Craniofacial Trauma Population

Lewin

Gelfond

Crumm

et al. 2022

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: Venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major complication in plastic surgery; however, there is a paucity of evidence about the incidence of VTE in the craniofacial subpopulation. We investigated the incidence and risk factors for VTE in the adult craniofacial trauma population. Methods: This retrospective review identified patients from the 2016 and 2017 Healthcare Cost and Utilization Project's National Inpatient Sample with a diagnosis for an initial encounter of a facial fracture. International Classification of Disease codes identified patients with DVT or PE. Groups were identified: adult craniofacial patients with and without a VTE diagnosis. The groups were analyzed to determine risk factors for developing a VTE during inpatient admissions. Results: A total of 203,240 patients were identified based on a diagnosis for an initial encounter of a facial fracture. Among those, 3350 (1.65%) were diagnosed with a DVT and 1455 (0.72%) with a PE. Risk factors for VTE were male sex (P = 0.011), longer hospital stay (P = 0.000), and higher Elixhauser comorbidity index (P = 0.000). Additionally, PE was an independent predictor of mortality [odds ratio (OR), 2.129] but DVT was not (OR, 1.148). Cranial and frontal fractures were independently associated with an increase in DVT (OR, 2.481) and PE (OR, 1.489). Conclusions: This study demonstrates that craniofacial trauma patients are at risk for VTE and should be risk-stratified for chemoprophylaxis therapy. Further studies in thromboembolism prophylaxis for facial fractures are warranted as the data are limited.

show abstract

“…Several studies have found that VTE prophylaxis strategies recommended in the guidelines may not be effective in patients with sepsis and septic shock [20]. The newly published AAST/ACSC expert consensus on the VTE prophylaxis in trauma patients also recommends that dose adjustment may be required according to anti-FXa levels after the rst use of enoxaparin [21]. Individualized use of anticoagulants to prevent VTE in critically ill patients may be the focus of future pharmacists.…”

Section: Guideline Compliancementioning

confidence: 99%

Impact of clinical pharmacist services on physicians’ guideline compliance and prognosis of patients for venous thromboembolism prophylaxis in ICU

Zhang¹,

Wang²,

Li³

et al. 2023

View full text Add to dashboard Cite

Purpose Whether the clinical pharmacist services (CPS) improve ICU physicians' compliance with venous thromboembolism (VTE) prophylaxis guidelines remains unclear, and its impact on VTE incidence and mortality in ICU patients should also be investigated.Methods ICU patients were assigned to CPS group or control group according to the medical arrangements of the day of patient admission without any intervention. The impact of CPS on guideline compliance, VTE incidence, and mortality was assessed.Results A total of 338 patients were included. With pharmacist intervention, ICU physicians' compliance with VTE prophylaxis guideline was improved by 7%-25% (p < 0.001). The incidences of VTE (9% vs 17%, p = 0.037) and bleeding events (5% vs 11%, p = 0.042) were both lower in the CPS group than in the control group. Multivariate Cox regression model showed that CPS was an independent risk factor for VTE events (HR = 0.438, 95% CI = 0.224-0.857, p = 0.016) and 14-day mortality (HR = 0.416, 95%CI = 0.25-0.692, p = 0.001).Conclusion CPS could signi cantly improve ICU physician compliance with VTE prophylaxis guidelines and reduce the incidence of VTE events and mortality in ICU patients. Clinical pharmacists should be involved in the daily management of ICU patients as an important member.

show abstract

American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma Clinical Protocol for inpatient venous thromboembolism prophylaxis after trauma

Cited by 54 publications

References 73 publications

One size does not fit all: Sex bias in pharmacologic venous thromboembolism prophylaxis

One size does not fit all: Sex bias in pharmacologic venous thromboembolism prophylaxis

National Trends in Venous Thromboembolism in the Adult Craniofacial Trauma Population

Impact of clinical pharmacist services on physicians’ guideline compliance and prognosis of patients for venous thromboembolism prophylaxis in ICU

Contact Info

Product

Resources

About