Should we be following anti-factor Xa levels in patients receiving prophylactic enoxaparin perioperatively?

Published:October 03, 2016DOI:
      Post-operative patients are known to be at increased risk for perioperative venous thromboembolism (VTE), a potentially life- or limb-threatening complication that affects patients across the spectrum of operations. Randomized, control trials as well as cohort studies have demonstrated clearly that the risk of VTE can be decreased with perioperative chemoprophylaxis, but these studies also demonstrate that risk reduction is not complete—the expected risk reduction is 50% in both randomized and nonrandomized studies. This means that 2–10% of the patients at greatest risk have a VTE event despite receipt of chemoprophylaxis; these “breakthrough” VTE events have substantial ramifications at the level of patients, hospital systems, and government entities that make and endorse guidelines.
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        • Faraklas I.
        • Ghanem M.
        • Brown A.
        • Cochran A.
        Evaluation of an enoxaparin dosing calculator using burn size and weight.
        J Burn Care Res. 2013; 34: 621-627
        • Berndtson A.E.
        • Costantini T.W.
        • Lane J.
        • Box K.
        • Coimbra R.
        If some is good, more is better: an enoxaparin dosing strategy to improve pharmacologic venous thromboembolism prophylaxis.
        J Trauma Acute Care Surg. 2016; ([Epub ahead of print])
      1. Pannucci CJ, Rockwell B, Fleming K, et al. Inadequate enoxaparin dosing predicts 90-day venous thromboembolism risk among plastic surgery inpatients: an examination of enoxaparin pharmcodynamics. Plast Reconstr Surg In Press.

        • Kopelman T.R.
        • O'Neill P.J.
        • Pieri P.G.
        • et al.
        Alternative dosing of prophylactic enoxaparin in the trauma patient: is more the answer?.
        Am J Surg. 2013; 206 (discussion 915-6): 911-915
        • Hiscock R.J.
        • Casey E.
        • Simmons S.W.
        • Walker S.P.
        • Newell P.A.
        Peak plasma anti-Xa levels after first and third doses of enoxaparin in women receiving weight-based thromboprophylaxis following caesarean section: a prospective cohort study.
        Int J Obstet Anesth. 2013; 22: 280-288