• Annika Bickford, Sarah Majercik, Joseph Bledsoe, Katie Smith, Rob Johnston, Justin Dickerson, and Tom White.
• Trauma Services, Intermountain Medical Center, 5121 S Cottonwood Street, Murray, UT 84157, USA. Electronic address: annika.bickford@imail.org.
• Am. J. Surg. 2013 Dec 1;206(6):847-51, discussion 851-2.

BackgroundLimited data exist regarding the efficacy of weight-based dosing of low-molecular weight heparin for venous thromboembolism (VTE) prophylaxis in obese trauma patients.MethodsConsecutive obese trauma patients were placed on a weight-based protocol for VTE prophylaxis (enoxaparin .5 mg/kg subcutaneously every 12 hours). Peak anti-Xa levels were drawn, and bilateral lower extremity duplex ultrasound was performed. The incidence of VTE and bleeding complications were recorded.ResultsEighty-six patients met the study criteria. Seventy-four patients achieved target prophylactic anti-Xa concentrations, with a mean level of .42 ± .01 IU/mL. Eighteen patients were found to have deep vein thrombosis. However, in 16 of these patients, deep vein thrombosis was diagnosed before weight-based low-molecular weight heparin initiation. No bleeding complications occurred, and no symptomatic pulmonary emboli were identified.ConclusionsIn obese trauma patients, weight-based enoxaparin is an efficacious regimen that provides adequate VTE prophylaxis, as measured by anti-Xa levels, and appears to be safe without bleeding complications.Copyright © 2013 Elsevier Inc. All rights reserved.

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