Introduction

Venous thromboembolism (VTE) is a major concern in hospitalized patients, especially trauma patients who are at higher risk due to coagulopathies and prolonged immobility. Low molecular weight heparins (LMWH), such as enoxaparin, are preferred for prophylaxis due to their favourable pharmacokinetic profile. Traditionally, enoxaparin 30 mg twice daily was the standard dose, but the Western Trauma Association’s 2020 guidelines recommended increasing the dose to 40 mg twice daily. This study aimed to compare clinical VTE incidence and safety outcomes before and after the guideline update.

Method

A retrospective, single-centre pre-post analysis was conducted at a level 1 trauma centre. Trauma patients admitted between May 2020 – June 2021 (pre-implementation, 30 mg twice daily) and June 2022 – May 2023 (post-implementation, 40 mg twice daily) were evaluated. The primary outcome was clinical VTE incidence (deep vein thrombosis or pulmonary embolism). Secondary outcomes included time to enoxaparin initiation and clinically significant bleeding events.

Results

• Patients: 300 total (150 in each group), with no significant baseline differences.
• VTE Incidence: No significant difference (4% pre vs. 2% post, p = 0.501).
• Time to Enoxaparin Initiation: Median time was 11.8 hours pre vs. 9.25 hours’ post (p = 0.672).
• Bleeding Events: Similar between groups (1.3% pre vs. 2% post, p = 0.462).

Conclusion

Increasing enoxaparin to 40 mg twice daily did not significantly impact VTE incidence or bleeding risk compared to the standard 30 mg regimen. These findings support the safety and potential efficacy of an increased dosing regimen, but further research is needed to confirm its clinical benefits.

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