Correlation of missed doses of enoxaparin with increased incidence of deep vein thrombosis in trauma and general surgery patients

Scott G. Louis, Misa Sato, Travis Geraci, Ross Anderson, S. David Cho, Philbert Van, Jeffrey S. Barton, Gordon M. Riha, Samantha Underwood, Jerome Differding, Jennifer Watters, Martin Schreiber

    Research output: Contribution to journalArticle

    52 Citations (Scopus)

    Abstract

    IMPORTANCE Enoxaparin sodium is widely used for deep vein thrombosis (DVT) prophylaxis, yet DVT rates remain high in the trauma and general surgery populations. Missed doses during hospitalization are common. OBJECTIVE To determine if missed doses of enoxaparin correlate with DVT formation. DESIGN, SETTING, AND PARTICIPANTS Data were prospectively collected among 202 trauma and general surgery patients admitted to a level I trauma center. MAIN OUTCOMES AND MEASURES Deep vein thrombosis screeningwas performed using a rigorous standardized protocol. RESULTS The overall incidence of DVT was 15.8%. In total, 58.9%of patients missed at least 1 dose of enoxaparin. The DVTs occurred in 23.5%of patients who missed at least 1 dose and in 4.8%of patients who did not (P <.01). On univariate analysis, the need for mechanical ventilation (71.8%vs 44.1%), the performance of more than 1 operation (59.3%vs 40.0%), and male sex (75%vs 56%) were associated with DVT formation (P <.05 for all). A bivariate logistic regression was then performed, which revealed age 50 years or older and interrupted enoxaparin therapy as the only independent risk factors for DVT formation. The DVT rate did not differ between trauma and general surgery populations or in patients receiving once-daily vs twice-daily dosing regimens. CONCLUSIONS AND RELEVANCE Interrupted enoxaparin therapy and age 50 years or older are associated with DVT formation among trauma and general surgery patients. Missed doses occur commonly and are the only identified risk factor for DVT that can be ameliorated by physicians. Efforts to minimize interrupted enoxaparin prophylaxis in patients at risk for DVT should be optimized.

    Original languageEnglish (US)
    Pages (from-to)365-370
    Number of pages6
    JournalJAMA Surgery
    Volume149
    Issue number4
    DOIs
    StatePublished - 2014

    Fingerprint

    Enoxaparin
    Venous Thrombosis
    Incidence
    Wounds and Injuries
    Trauma Centers
    Artificial Respiration
    Population
    Hospitalization
    Logistic Models
    Sodium

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Correlation of missed doses of enoxaparin with increased incidence of deep vein thrombosis in trauma and general surgery patients. / Louis, Scott G.; Sato, Misa; Geraci, Travis; Anderson, Ross; Cho, S. David; Van, Philbert; Barton, Jeffrey S.; Riha, Gordon M.; Underwood, Samantha; Differding, Jerome; Watters, Jennifer; Schreiber, Martin.

    In: JAMA Surgery, Vol. 149, No. 4, 2014, p. 365-370.

    Research output: Contribution to journalArticle

    Louis, Scott G. ; Sato, Misa ; Geraci, Travis ; Anderson, Ross ; Cho, S. David ; Van, Philbert ; Barton, Jeffrey S. ; Riha, Gordon M. ; Underwood, Samantha ; Differding, Jerome ; Watters, Jennifer ; Schreiber, Martin. / Correlation of missed doses of enoxaparin with increased incidence of deep vein thrombosis in trauma and general surgery patients. In: JAMA Surgery. 2014 ; Vol. 149, No. 4. pp. 365-370.
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    abstract = "IMPORTANCE Enoxaparin sodium is widely used for deep vein thrombosis (DVT) prophylaxis, yet DVT rates remain high in the trauma and general surgery populations. Missed doses during hospitalization are common. OBJECTIVE To determine if missed doses of enoxaparin correlate with DVT formation. DESIGN, SETTING, AND PARTICIPANTS Data were prospectively collected among 202 trauma and general surgery patients admitted to a level I trauma center. MAIN OUTCOMES AND MEASURES Deep vein thrombosis screeningwas performed using a rigorous standardized protocol. RESULTS The overall incidence of DVT was 15.8{\%}. In total, 58.9{\%}of patients missed at least 1 dose of enoxaparin. The DVTs occurred in 23.5{\%}of patients who missed at least 1 dose and in 4.8{\%}of patients who did not (P <.01). On univariate analysis, the need for mechanical ventilation (71.8{\%}vs 44.1{\%}), the performance of more than 1 operation (59.3{\%}vs 40.0{\%}), and male sex (75{\%}vs 56{\%}) were associated with DVT formation (P <.05 for all). A bivariate logistic regression was then performed, which revealed age 50 years or older and interrupted enoxaparin therapy as the only independent risk factors for DVT formation. The DVT rate did not differ between trauma and general surgery populations or in patients receiving once-daily vs twice-daily dosing regimens. CONCLUSIONS AND RELEVANCE Interrupted enoxaparin therapy and age 50 years or older are associated with DVT formation among trauma and general surgery patients. Missed doses occur commonly and are the only identified risk factor for DVT that can be ameliorated by physicians. Efforts to minimize interrupted enoxaparin prophylaxis in patients at risk for DVT should be optimized.",
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    T1 - Correlation of missed doses of enoxaparin with increased incidence of deep vein thrombosis in trauma and general surgery patients

    AU - Louis, Scott G.

    AU - Sato, Misa

    AU - Geraci, Travis

    AU - Anderson, Ross

    AU - Cho, S. David

    AU - Van, Philbert

    AU - Barton, Jeffrey S.

    AU - Riha, Gordon M.

    AU - Underwood, Samantha

    AU - Differding, Jerome

    AU - Watters, Jennifer

    AU - Schreiber, Martin

    PY - 2014

    Y1 - 2014

    N2 - IMPORTANCE Enoxaparin sodium is widely used for deep vein thrombosis (DVT) prophylaxis, yet DVT rates remain high in the trauma and general surgery populations. Missed doses during hospitalization are common. OBJECTIVE To determine if missed doses of enoxaparin correlate with DVT formation. DESIGN, SETTING, AND PARTICIPANTS Data were prospectively collected among 202 trauma and general surgery patients admitted to a level I trauma center. MAIN OUTCOMES AND MEASURES Deep vein thrombosis screeningwas performed using a rigorous standardized protocol. RESULTS The overall incidence of DVT was 15.8%. In total, 58.9%of patients missed at least 1 dose of enoxaparin. The DVTs occurred in 23.5%of patients who missed at least 1 dose and in 4.8%of patients who did not (P <.01). On univariate analysis, the need for mechanical ventilation (71.8%vs 44.1%), the performance of more than 1 operation (59.3%vs 40.0%), and male sex (75%vs 56%) were associated with DVT formation (P <.05 for all). A bivariate logistic regression was then performed, which revealed age 50 years or older and interrupted enoxaparin therapy as the only independent risk factors for DVT formation. The DVT rate did not differ between trauma and general surgery populations or in patients receiving once-daily vs twice-daily dosing regimens. CONCLUSIONS AND RELEVANCE Interrupted enoxaparin therapy and age 50 years or older are associated with DVT formation among trauma and general surgery patients. Missed doses occur commonly and are the only identified risk factor for DVT that can be ameliorated by physicians. Efforts to minimize interrupted enoxaparin prophylaxis in patients at risk for DVT should be optimized.

    AB - IMPORTANCE Enoxaparin sodium is widely used for deep vein thrombosis (DVT) prophylaxis, yet DVT rates remain high in the trauma and general surgery populations. Missed doses during hospitalization are common. OBJECTIVE To determine if missed doses of enoxaparin correlate with DVT formation. DESIGN, SETTING, AND PARTICIPANTS Data were prospectively collected among 202 trauma and general surgery patients admitted to a level I trauma center. MAIN OUTCOMES AND MEASURES Deep vein thrombosis screeningwas performed using a rigorous standardized protocol. RESULTS The overall incidence of DVT was 15.8%. In total, 58.9%of patients missed at least 1 dose of enoxaparin. The DVTs occurred in 23.5%of patients who missed at least 1 dose and in 4.8%of patients who did not (P <.01). On univariate analysis, the need for mechanical ventilation (71.8%vs 44.1%), the performance of more than 1 operation (59.3%vs 40.0%), and male sex (75%vs 56%) were associated with DVT formation (P <.05 for all). A bivariate logistic regression was then performed, which revealed age 50 years or older and interrupted enoxaparin therapy as the only independent risk factors for DVT formation. The DVT rate did not differ between trauma and general surgery populations or in patients receiving once-daily vs twice-daily dosing regimens. CONCLUSIONS AND RELEVANCE Interrupted enoxaparin therapy and age 50 years or older are associated with DVT formation among trauma and general surgery patients. Missed doses occur commonly and are the only identified risk factor for DVT that can be ameliorated by physicians. Efforts to minimize interrupted enoxaparin prophylaxis in patients at risk for DVT should be optimized.

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    U2 - 10.1001/jamasurg.2013.3963

    DO - 10.1001/jamasurg.2013.3963

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    SN - 2168-6254

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