Utility of anti-factor Xa monitoring in surgical patients receiving prophylactic doses of enoxaparin for venous thromboembolism prophylaxis
Copyright © 2016 Elsevier Inc. All rights reserved..
BACKGROUND: Between 2% and 10% of the highest risk surgery, patients have a "breakthrough" venous thromboembolism (VTE) event despite receipt of chemoprophylaxis. The goals of this review are to summarize how patient-level factors may predict enoxaparin metabolism and how alterations in enoxaparin dose magnitude and frequency affect both anti-factor Xa (aFXa) levels and downstream VTE events.
DATA SOURCES: Relevant articles were identified on PubMed. Fixed-dose prophylaxis provides inadequate enoxaparin prophylaxis for most surgical patients based on anti-factor Xa levels. Inadequate enoxaparin dosing has been correlated with both asymptomatic and symptomatic VTE events. Patient-level factors such as gross weight and extent of injury predict enoxaparin metabolism. Weight-based or weight-tiered dosing regimens-and real-time dose adjustment based on anti-factor Xa levels-allow an increased proportion of patients to have in-range anti-factor Xa levels.
CONCLUSIONS: Inadequate enoxaparin dosing may explain why some patients have VTE despite enoxaparin prophylaxis. Ongoing research in the utility of weight-based or anti-factor Xa level driven enoxaparin dosing and dose adjustment is reasonable.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:213 |
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| Enthalten in: |
American journal of surgery - 213(2017), 6 vom: 19. Juni, Seite 1143-1152 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Pannucci, Christopher J [VerfasserIn] |
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| Links: |
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| Themen: |
Anti-factor Xa |
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| Anmerkungen: |
Date Completed 21.08.2017 Date Revised 21.08.2017 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.amjsurg.2016.08.010 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM264893921 |
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| 245 | 1 | 0 | |a Utility of anti-factor Xa monitoring in surgical patients receiving prophylactic doses of enoxaparin for venous thromboembolism prophylaxis |
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| 500 | |a Date Completed 21.08.2017 | ||
| 500 | |a Date Revised 21.08.2017 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2016 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Between 2% and 10% of the highest risk surgery, patients have a "breakthrough" venous thromboembolism (VTE) event despite receipt of chemoprophylaxis. The goals of this review are to summarize how patient-level factors may predict enoxaparin metabolism and how alterations in enoxaparin dose magnitude and frequency affect both anti-factor Xa (aFXa) levels and downstream VTE events | ||
| 520 | |a DATA SOURCES: Relevant articles were identified on PubMed. Fixed-dose prophylaxis provides inadequate enoxaparin prophylaxis for most surgical patients based on anti-factor Xa levels. Inadequate enoxaparin dosing has been correlated with both asymptomatic and symptomatic VTE events. Patient-level factors such as gross weight and extent of injury predict enoxaparin metabolism. Weight-based or weight-tiered dosing regimens-and real-time dose adjustment based on anti-factor Xa levels-allow an increased proportion of patients to have in-range anti-factor Xa levels | ||
| 520 | |a CONCLUSIONS: Inadequate enoxaparin dosing may explain why some patients have VTE despite enoxaparin prophylaxis. Ongoing research in the utility of weight-based or anti-factor Xa level driven enoxaparin dosing and dose adjustment is reasonable | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Anti-factor Xa | |
| 650 | 4 | |a Deep venous thrombosis | |
| 650 | 4 | |a Drug metabolism | |
| 650 | 4 | |a Enoxaparin | |
| 650 | 4 | |a Pulmonary embolus | |
| 650 | 4 | |a Venous thromboembolism | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 650 | 7 | |a Enoxaparin |2 NLM | |
| 650 | 7 | |a Factor Xa Inhibitors |2 NLM | |
| 700 | 1 | |a Prazak, Ann Marie |e verfasserin |4 aut | |
| 700 | 1 | |a Scheefer, Melody |e verfasserin |4 aut | |
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