(1590) Comparison of Enoxaparin Dosing in Critically Ill Trauma Patients Before and After Guideline Update

Introduction: Venous thromboembolism (VTE) prophylaxis is imperative for preventing thrombus formation in patients with traumatic injuries. The reported incidence of VTE is 30-60% in the trauma population. Patients with Injury Severity Scores (ISS) >10 should be started on prophylaxis while considering bleed risk. The Western Trauma Association published guidelines detailing dosing strategies based on injury type, severity, and risk factors for bleeding. The goal of this study was to assess institution adherence to guidelines prior to and after education of the surgery department.

Methods: This retrospective study evaluated adult patients receiving VTE prophylaxis while admitted to the trauma service at a level II trauma center. Patients were identified via an institutional trauma registry. Pharmacologic dosing strategies relative to guideline recommendations were compared pre and post publication. The primary outcome was the adherence rate of VTE prophylaxis dosing to the WTA recommendations. Safety outcomes included the incidence of VTE formation and bleeding. Enoxaparin Anti-Xa levels were collected, when available, to assess for appropriate dose adjustments.

Results: Of the patients review, 90 met inclusion criteria (pre n=47, post=43). There was no difference in study group ages (pre 54±23, post 56±24), BMIs (pre 27±5, post 27±8), and male sex (pre 68%, post 65%). ISS scores were 17.5±10.5 pre and 20.8±12.2 post (p=0.36). Adherence rates to WTA recommendations were 55% pre education and 77% post education (p=0.82). VTEs developed in one patient in each group. The incidence of bleeding events was 2.1% pre and 7% post (p=0.087). A similar number of Anti-Xa levels were collected, and doses were all appropriately adjusted. There was no difference in ICU or hospital lengths of stay.

Conclusions: Patients with major traumas received appropriate VTE prophylaxis more frequently post guideline education; however, adherence remains suboptimal. While there was no difference in CTE formation or bleeding, the sample population was small. Trauma centers should create institution specific protocols for pharmacologic dose adjustments according to current guidelines.