Michelle Lai, PharmD
PGY2 Critical Care Pharmacy Resident
UC San Diego Medical Center
San Diego
Disclosure information not submitted.
Audrey Bushway, PharmD, BCCCP
Inpatient Staff Pharmacist
UC San Diego Health, United States
Disclosure information not submitted.
Jeanne Lee, MD, FACS
Director, Burn Center
UC San Diego Health, United States
Disclosure information not submitted.
Laura Godat, MD, FACS
Medical Director, Surgical Intensive Care Unit
UC San Diego Health, United States
Disclosure information not submitted.
Title: Enoxaparin in Burn Patients on Renal Replacement Therapy
INTRODUCTION/HYPOTHESIS: Patients with acute burn injury are at increased risk of complications, including venous thromboembolism (VTE) and renal failure. Previous studies have shown that standard enoxaparin dosing for VTE prophylaxis is inadequate in burn patients and increased doses may be warranted. However, enoxaparin is renally cleared and has been shown to accumulate in renal failure. This study aimed to evaluate the safety and efficacy of enoxaparin for VTE prophylaxis and treatment in burn patients on continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD).
Methods: A single-center retrospective review was performed on patients admitted to the burn service between July 2015 and December 2020 who were ≥ 18 years old, received at least one dose of enoxaparin while on renal replacement therapy, and at least one measured peak plasma anti-Xa level. Appropriately drawn anti-Xa levels, defined as being drawn 3-6 hours after at least 3 serial enoxaparin doses, were included in analysis. Target anti-Xa levels were 0.2-0.4 IU/mL and 0.5-1 IU/mL for VTE prophylaxis and VTE treatment/atrial fibrillation, respectively.
Results: Of 38 patients screened, 28 patients met inclusion criteria. A new diagnosis of deep vein thrombosis (DVT) or pulmonary embolism (PE) occurred in 19 patients (67.9 %) during admission. Among the 28 patients, 233 anti-Xa levels were assessed, with a median [IQR] of 6.5 [2-10] levels per patient. For VTE prophylaxis while on CRRT, 49/92 (53.3%), 30/92 (32.6%), and 13/92 (14.1%) of levels were at, below, and above goal, respectively. For VTE prophylaxis while on IHD, 36/55 (65.5%), 15/55 (27.3%), and 4/55 (7.3%) of levels were at, below, and above goal, respectively. For VTE treatment or atrial fibrillation while on CRRT, 32/48 (66.7%), 11/48 (22.9%), and 5/48 (10.4%) of levels were at, below, and above goal, respectively. Lastly, for VTE treatment or atrial fibrillation while on IHD, 22/38 (57.9%) and 16/38 (42.1%) of levels were at or below goal, respectively.
Conclusions: Enoxaparin dose adjustments are warranted to achieve target anti-Xa levels for VTE prophylaxis and treatment in acute burn patients requiring renal replacement therapy.