Pharmacotherapy. 2023 Dec 13. doi: 10.1002/phar.2900. Online ahead of print.
ABSTRACT
BACKGROUND: Most patients receiving Low-molecular-weight heparin therapy do not require routine coagulation monitoring, but due to uncertainty in certain populations, clinicians may feel compelled to perform anti-Xa monitoring.
METHODS: This retrospective cohort study compared clinical outcomes in propensity-score matched adult inpatients from an academic health care system who did and did not receive anti-Xa monitoring of enoxaparin for venous thromboembolism prophylaxis. The primary outcome was the composite of any venous thromboembolism, any bleeding, and mortality in the 30 days following enoxaparin initiation. Secondary outcomes were the individual components of the composite outcome and major bleeding.
RESULTS: During the 13-month study period, a total of 6,611 patients received enoxaparin for venous thromboembolism prophylaxis, 301 in the anti-Xa monitored group and 6,310 in the unmonitored group (4.6% received monitoring). The mean age was 52.9 years and 52% of patients were male. The mean body mass index was 31 kg/m2 and the mean creatinine clearance was 109 mL/min. Twenty percent of patients had active cancer. The most common indication for enoxaparin prophylaxis was hospitalization for medical illness (52%) followed by non-orthopedic surgery (37%). The adjusted odds ratio for the primary outcome comparing monitored to unmonitored patients was 1.26 (95% confidence interval, 0.75-2.11). None of the between group differences in the individual components of the composite outcome were statistically significant.
CONCLUSIONS: Thirty-day clinical outcomes in patients receiving enoxaparin for venous thromboembolism prophylaxis were not improved by anti-Xa monitoring. Our results support current evidence-based guideline recommendations against anti-Xa monitoring for patients receiving enoxaparin for venous thromboembolism prophylaxis.
PMID:38088033 | DOI:10.1002/phar.2900
