Inability to Predict Sub-Prophylactic Anti-Factor Xa Levels in Trauma Patients Receiving Early Low Molecular-Weight Heparin

Background Standard low molecular-weight heparin dosing may be suboptimal for venous thromboembolism prophylaxis. We aimed to identify independent predictors of sub-prophylactic Xa (subXa) levels in trauma patients treated under a novel early chemoprophylaxis algorithm. Methods A retrospective analysis of trauma patients from July 2016 to June 2017 who received enoxaparin 40 mg BID and had peak Xa levels drawn was performed. Patients were divided into cohorts based on having a subXa ( 0.4 IU/mL. Of the subXa cohort, 35 (92%) had their dosage increased and the repeat Xa testing that was done in 32 revealed that only 75% reached prophylactic levels. The median time to the initiation of chemoprophylaxis was 21.9 hours (IQR 11.45 – 35.07). Patients who were defined as having lower risk for having a complication as a result of bleeding had a shorter time to starting prophylaxis than those at higher risk (18.39 hours [IQR 5.76 – 26.51] vs. 29.5 hours [IQR 16.23 – 63.07], p

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