• Darren Malinoski, Fariba Jafari, Tyler Ewing, Chris Ardary, Heather Conniff, Mark Baje, Allen Kong, Michael E Lekawa, Matthew O Dolich, Marianne E Cinat, Cristobal Barrios, and David B Hoyt.
• Department of Surgery, University of California, Irvine Medical Center, Orange, California 92868, USA. malinosd@uci.edu
• J Trauma. 2010 Apr 1;68(4):874-80.

BackgroundDeep venous thromboses (DVT) continue to cause significant morbidity in critically ill patients. Standard prophylaxis for high risk patients includes twice-daily dosing with 30 mg enoxaparin. Despite prophylaxis, DVT rates still exceed 10% to 15%. Anti-Xa levels are used to measure the activity of enoxaparin and 12-hour trough levels MethodsAll patients on the surgical intensive care unit (ICU) service were prospectively followed. In the absence of contraindications, patients were given prophylactic enoxaparin and anti-Xa levels were drawn after the third dose. Trough levels ResultsData were complete for 54 patients. Eighty-five percent suffered trauma (Injury Severity Score of 25 +/- 12) and 74% were male. Overall, 27 patients (50%) had low anti-Xa levels. Patients with low anti-Xa levels had significantly more DVTs than those with normal levels (37% vs. 11%, p = 0.026), despite similar age, body mass index, Injury Severity Score, creatinine clearance, high risk injuries, and ICU/ventilator days.ConclusionStandard dosing of enoxaparin leads to low anti-Xa levels in half of surgical ICU patients. Low levels are associated with a significant increase in the risk of DVT. These data support future studies using adjusted-dose enoxaparin.

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