Inadequate Enoxaparin Dosing Predicts 90-Day Venous Thromboembolism Risk among Plastic Surgery Inpatients: An Examination of Enoxaparin Pharmacodynamics.

摘要: Background Evidence-based plastic surgery guidelines support the effectiveness of once-daily enoxaparin prophylaxis. Despite prophylaxis, one in 25 highest risk patients has a venous thromboembolism event. The authors examined pharmacodynamics standard doses to examine whether patient-level factors predict metabolism, inadequate dose predicts downstream events, and pharmacist-driven dose-adjustment protocol was effective. Methods recruited adult who received postoperative at 40 mg/day. Steady-state peak anti-factor Xa levels, marker safety, were determined. Patients with out-of-range levels had real-time adjustment based on written protocol. followed for 90-day events. Results Ninety-four recruited, 44 percent in-range response dosing. Patient-level including extent surgical injury gross weight independent predictors metabolism. low significantly more likely have (10.2 versus 0 percent; p = 0.041). Real-time allowed increased proportion (67.1 44.3 0.002). Conclusions Based pharmacodynamic data, majority receive prophylaxis using fixed can how will metabolize enoxaparin, are Individualization may minimize perioperative further improve patient safety after reconstructive procedures. Clinical question/level evidence Therapeutic, II.