Anti-Xa Monitoring for VTE Prophylaxis with Enoxaparin in Adult Trauma Patients

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Trauma patients are at high risk for venous thromboembolism (VTE), a major contributor to delayed mortality; therefore, enoxaparin is routinely used for VTE prophylaxis. Current recommendations for dosing are based on patient weight, serum creatinine, age, and type of trauma. Anti-Xa levels may be used to assess enoxaparin efficacy, with a prophylactic peak goal considered 0.2-0.4 IU/mL. Evidence remains unclear regarding whether routine anti-Xa monitoring improves VTE occurrence in trauma patients when receiving appropriate initial dosing of enoxaparin. This study aims to evaluate the impact of routine anti-Xa level monitoring on VTE incidence in trauma patients by examining the time to reach prophylactic levels, including the number of doses and dose adjustments required. Findings will help determine if monitoring should be applied universally or targeted to high-risk subgroups.

This retrospective cohort study evaluated adult trauma patients admitted to Corewell Health facilities who received prophylactic enoxaparin between August 1, 2024, and August 31, 2025. Eligible patients must be ≥18 years old, admitted to the trauma service line, and received at least three doses of prophylactic enoxaparin within 96 hours of hospitalization. Patients were stratified into two cohorts: those who underwent anti-Xa level monitoring and those who did not. Data collected included demographics, injury characteristics, enoxaparin dosing details, anti-Xa levels, thrombotic events, bleeding events, known coagulation disorders, and prior/concurrent use of medications with anticoagulation/antiplatelet properties. The primary outcome assessed VTE incidence between groups. Secondary analyses evaluated bleeding rates, time to therapeutic anti-Xa levels, and dose adjustments required to achieve prophylactic range.

An initial sample of 342 patients from the study timeframe has been reviewed for eligibility. When completed, the results of this study will be used to inform current institutional practices pertaining to timing and necessity of anti-Xa level monitoring in adult trauma patients receiving enoxaparin for VTE prophylaxis.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1989

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