Enoxaparin for VTE thromboprophylaxis during inpatient rehabilitation care: assessment of the standard fixed dosing regimen

BMC Pharmacology and Toxicology, 2024 · DOI: https://doi.org/10.1186/s40360-023-00728-0 · Published: January 1, 2024

Cardiovascular Science Pharmacology Rehabilitation

Simple Explanation

This study investigates whether a standard dose of the blood thinner enoxaparin is effective in preventing blood clots in rehabilitation patients. The study found that a fixed dose of enoxaparin may not be adequate for all rehabilitation patients, as some had too little or too much of the drug in their system. Weight and kidney function were found to influence the effectiveness of enoxaparin, suggesting that a personalized approach may be needed.

Study Duration

August 2018 to November 2019

Participants

63 hospitalized patients undergoing rehabilitative treatment following sub-acute ischemic stroke (SAIS) or spinal cord injury (SCI)

Evidence Level

Observational, prospective, cohort study

Key Findings

1
Fixed-dose enoxaparin prophylaxis resulted in sub-prophylactic anti-Xa levels in 19% of patients and supra-prophylactic levels in 7.9% of patients.
2
Anti-Xa levels were inversely correlated with patients’ weight and renal function as defined by creatinine clearance (CrCl).
3
Multivariate analysis identified weight and female sex as significant factors influencing anti-Xa activity.

Research Summary

This study examined the efficiency of fixed-dose enoxaparin for VTE prophylaxis in rehabilitation patients after SAIS or SCI. The study found that a fixed dose may be inadequate for a significant proportion of patients, with 27% having non-therapeutic anti-Xa levels. Weight and renal function were identified as key factors influencing enoxaparin activity, suggesting the need for a personalized approach to VTE prophylaxis in this population.

Practical Implications

Personalized Dosing

Consider anti-Xa monitoring and dose adjustments in rehabilitation patients, especially those who are underweight, overweight, or have impaired renal function.

Further Research

Conduct more studies to establish VTE prophylactic dosing guidelines tailored to specific rehabilitation populations, considering the interaction of weight and creatinine clearance.

Clinical Awareness

Clinicians should be aware that fixed-dose enoxaparin prophylaxis may not provide adequate therapeutic response for all rehabilitation patients.

Study Limitations

1
Small sample size
2
Data is only valid for the sub-groups tested (SAIS and SCI)
3
Study was not designed for a systematic evaluation of bleeding or VTE-related events

Your Feedback

Was this summary helpful?

Back to Cardiovascular Science