PulmCrit (EMCrit)
PulmCrit – May 25, 2020 - By Josh Farkas
"Summary: The bullet
- There is no Level-I evidence regarding the optimal dose of enoxaparin for DVT prophylaxis among critically ill patients. Critical illness increases both the risk of venous thromboembolic disease and resistance to enoxaparin, so these patients may require a more aggressive anticoagulation strategy.
- The practice of giving patients 40 mg enoxaparin daily is based more on convenience than on evidence. Nearly every study which has evaluated drug levels resulting from this strategy among critically ill patients has found substantial problems with it.
- Recent studies seem to be converging on a strategy of twice-daily, weight-based enoxaparin (~0.5 mg/kg sq. BID). Given variability in pharmacokinetics between patients, therapeutic drug monitoring may help optimize the dose (especially among patients with unusual weight, renal dysfunction, or extreme illness severity).
- It’s common for ICU patients to develop thromboembolic disease despite receiving DVT prophylaxis. Rather than patients’ failing to respond to DVT prophylaxis, it’s possible that we’re failing to optimize their dose."