Increased Enoxaparin Dosing Requirements for Treatment of Deep Vein Thrombosis in a Severely Burned Patient: Case Report and Literature Review

Abstract

Dosing of enoxaparin for deep vein thrombosis (DVT) prophylaxis in acutely burned patients has been shown to result in anti‐Xa levels below target range. We describe the first case report, to our knowledge, of a severely burned patient who, despite prophylactic dosing of enoxaparin 30 mg subcutaneously twice daily, developed an acute DVT that required high‐dose enoxaparin (100 mg [1.5 mg/kg] subcutaneously every 8 hours) to maintain anti‐Xa levels within the therapeutic range (0.6–1 IU/ml). Pharmacokinetic evaluations were performed using anti‐Xa levels measured throughout the patient's hospital stay to validate the appropriateness of this high‐dose regimen based on established therapeutic anti‐Xa level ranges. These results suggest that routine anti‐Xa level monitoring, regardless of enoxaparin dosing, is necessary for burn patients who are receiving enoxaparin given their hypermetabolic state following injury.

Comparison of the Effects of Injectable Enoxaparin With Oral Rivaroxaban in Deep Vein Thrombotic Prophylaxis in Patients With Femoral Peritrochanteric Fracture: A Randomized Clinical Trial

“…The benefits of this drug include lower risk of bleeding due to low immunogenicity, reduced risk of thrombocytopenia, higher bioavailability due to lower binding to plasma proteins, plasma, and endothelium, predictable anticoagulant effects, and ease of use. This drug is routinely used subcutaneously in Iran after orthopedic surgery (19)(20)(21). The use of rivaroxaban has also increased in orthopedic major surgery recently.…”