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Low anti-Factor Xa level predicts 90-day Symptomatic Venous Thromboembolism in Surgical Patients Receiving Enoxaparin Prophylaxis: A Pooled Analysis of Eight Clinical Trials

Pannucci, Christopher J ; Fleming, Kory I ; Varghese, Thomas K ; Stringham, John ; Huang, Lyen C ; Pickron, T Bartley ; Prazak, Ann Marie ; Bertolaccini, Corinne ; Momeni, Arash

Annals of surgery, 2022-12, Vol.276 (6), p.e682-e690 [Periódico revisado por pares]

United States: Copyright Wolters Kluwer Health, Inc. All rights reserved

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  • Título:
    Low anti-Factor Xa level predicts 90-day Symptomatic Venous Thromboembolism in Surgical Patients Receiving Enoxaparin Prophylaxis: A Pooled Analysis of Eight Clinical Trials
  • Autor: Pannucci, Christopher J ; Fleming, Kory I ; Varghese, Thomas K ; Stringham, John ; Huang, Lyen C ; Pickron, T Bartley ; Prazak, Ann Marie ; Bertolaccini, Corinne ; Momeni, Arash
  • Assuntos: Anticoagulants - therapeutic use ; Enoxaparin - therapeutic use ; Humans ; Postoperative Complications - drug therapy ; Postoperative Complications - epidemiology ; Postoperative Complications - prevention & control ; Postoperative Hemorrhage ; Prospective Studies ; Venous Thromboembolism - etiology ; Venous Thromboembolism - prevention & control
  • É parte de: Annals of surgery, 2022-12, Vol.276 (6), p.e682-e690
  • Notas: ObjectType-Article-2
    SourceType-Scholarly Journals-1
    ObjectType-Feature-1
    content type line 23
  • Descrição: OBJECTIVE:To examine the relationship between enoxaparin dose adequacy, quantified with anti-Factor Xa (aFXa) levels, and 90-day symptomatic venous thromboembolism (VTE) and post-operative bleeding. SUMMARY BACKGROUND DATA:Surgical patients often develop “breakthrough” VTE events—those which occur despite receiving chemical anticoagulation. We hypothesize that surgical patients with low aFXa levels will be more likely to develop 90-day VTE, and those with high aFXa will be more likely to bleed. METHODS:Pooled analysis of eight clinical trials (N = 985) from a single institution over a four year period. Patients had peak steady state aFXa levels in response to a known initial enoxaparin dose, and were followed for 90 days. Survival analysis log-rank test examined associations between aFXa level category and 90-day symptomatic VTE & bleeding. RESULTS:Among 985 patients, 2.3% (n = 23) had symptomatic 90-day VTE, 4.2% (n = 41) had 90-day clinically relevant bleeding, and 2.1% (n = 21) had major bleeding. Patients with initial low aFXa were significantly more likely to have 90-day VTE than patients with adequate or high aFXa (4.2% vs. 1.3%, p = 0.007). In a stratified analysis, this relationship was significant for patients who received twice daily (6.2% vs. 1.5%, p = 0.003), but not once daily (3.0% vs. 0.7%, p = 0.10) enoxaparin. No association was seen between high aFXa and 90-day clinically relevant bleeding (4.8% vs. 2.9%, p = 0.34) or major bleeding (3.6% vs. 1.6%, p = 0.18). CONCLUSIONS:This manuscript establishes inadequate enoxaparin dosing as a plausible mechanism for breakthrough VTE in surgical patients, and identifies anticoagulant dose adequacy as a novel target for process improvement measures.
  • Editor: United States: Copyright Wolters Kluwer Health, Inc. All rights reserved
  • Idioma: Inglês
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