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  • Poster
  • PS14.14

Protocolizing venous thrombo-embolism prophylaxis using Anti Xa in trauma: Experience from the national trauma center in Qatar

Ahmad Kloub
Doha / QA

Appointment

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Poster session 14

Poster

Protocolizing venous thrombo-embolism prophylaxis using Anti Xa in trauma: Experience from the national trauma center in Qatar

Session

Visceral trauma 1

Topics

  • Polytrauma
  • Visceral trauma

Authors

Ahmad Kloub (Doha / QA), Abu Baker Al Aieb (Doha / QA), Ahad Kanbar (Doha / QA), Suha Abu Musa (Doha / QA), Naushad Ahmad Khan (Doha / QA), Mohammad Asem (Doha / QA), Ayman El-Menyar (Doha / QA), Sandro Rizoli (Doha / QA), Hassan Al-Thani (Doha / QA)

Abstract

Introduction: Venous Thromboembolism (VTE) in trauma carries a significant mortality and morbidity. Even tough low molecular weight heparin (LMWH) is the standard for VTE prophylaxis, the timing of LMWH initiation, optimal dosing, and anti Xa monitoring remain controversial.

Objectives: : To determine the impact of a VTE prophylaxis protocol recommending early LMWH initiation, twice daily dosing, and anti-Xa based dose adjustment on VTE in trauma.

Methods: all adult trauma patients admitted to the Trauma ICU in a Level 1 Trauma Center, 10 months before and after implementation of a VTE protocol were included. Outcome was VTE rate and bleeding episodes in the post implementation group. Protocol mandated Enoxaparin 30 mg twice daily starting 24-36h post admission with peak anti Xa activity measured 4h after 3rd dose. Dosing was adjusted according to BMI, glomerular filtration rate, traumatic brain injury (TBI), age (>65), and a anti Xa level between 0.2-0.4 IU/ml. Berne-Norwood criteria was used in initiating prophylaxis in TBI.

Results: Protocol implementation was associated with a significant reduction in VTE, pre-implementation 4.7% (17 of 362 patients), post-implementation 1.6% (7/438). Data adjustment and multivariate analysis further revealed protocol introduction significant association with less VTE (adjusted odds ratio: 0.27 (0.088-0.882), p= 0.03). All 8 patients (1.8 %) who bled while on prophylaxis were audited. In 7 (87.5%), the bleeding was considered unrelated to the LMWH and the anti Xa levels Below 0.4 (median 0.29 IU/ml (0.15-0.52). Only one patient had anti Xa level 0.52IU/ml. Median initiation time for these 8 patients was 27hrs. (19-60)

Conclusion: Instituting a protocol for VTE prophylaxis (described above), in traumatized adult patients admitted to ICU, resulted in substantial reduction in VTE rates. Dose adjustment according to anti Xa levels may prove to be safe and improve outcomes. Further studies are warranted.

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