Enoxaparin Titration for Venous Thromboembolism Prophylaxis in the Burn Injured Patient - A Single Center Experience.

Burn injured patients develop altered metabolic processes predisposing them to venous thromboembolism and bleeding. Enoxaparin titration for venous thromboembolism prevention in trauma patients is safe, but this approach is not well defined in burn injured patients. We hypothesized that titration of enoxaparin in burn patients is safe and does not increase bleeding risk. We compared a fixed dose 30 mg twice-daily enoxaparin dosing regimen to anti-Xa guided, twice-daily enoxaparin titration. Trough anti-Xa levels were measured and adjusted by 10 mg intervals with repeat anti-Xa levels measured before administration of the fourth or fifth dose. Starting dose in the titrated group was determined by injury type, patient characteristics, and renal clearance as per American Association of Surgeons in Trauma guidelines. 152 patients were included. 93 received fixed dosing and 59 were titrated by anti-Xa levels. There were 16 total incidents of bleeding but no difference between the two groups (p=.67). Univariate analysis revealed no differences in patient demographics or comorbidities between those with and without bleeding. When comparing dosing trends, fourteen of twenty patients (70%) initiated at 30 mg were at goal anti-Xa level on initial check, while five (25%) were sub-therapeutic, and one (5%) was supratherapeutic. Comparatively, twenty-four of thirty-nine patients (62%) started at 40 mg were at goal anti-Xa level on initial check, while nine (23%) were subtherapeutic and six (15%) were supratherapeutic. We observed that enoxaparin titration does not significantly increase bleeding risk. Larger studies are needed to confirm these findings and determine its effect on venous thromboembolism prevention.