Optimizing Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in Trauma Patients

Introduction: Venous thromboembolism (VTE) is a common but potentially avoidable complication in hospitalized patients, and trauma patients are particularly susceptible due to coagulopathies and prolonged immobility. Previous literature supports low molecular weight heparins (LMWH), such as enoxaparin, as the prophylactic agent of choice due to its increased bioavailability, longer plasma half-life, and predictable pharmacokinetics. Standard enoxaparin dosing in trauma patients was 30 mg twice daily until the Western Trauma Association released updated guidelines in 2020 recommending an increased dosing regimen of enoxaparin 40 mg twice daily. The objective of this study was to compare the incidence of clinical VTE and safety pre and post guideline implementation.


Methods: This was a retrospective, single-center, pre-post analysis of trauma patients receiving prophylactic enoxaparin at a level 1 trauma center. Patients admitted to a trauma service from May 2020 – June 2021 or June 2022 – May 2023 were evaluated. The pre-implementation group received enoxaparin 30 mg twice daily while the post-implementation group received enoxaparin 40 mg twice daily. The primary endpoint was incidence of clinical VTE, defined as deep vein thrombosis or pulmonary embolism. Secondary endpoints included time to enoxaparin initiation and clinically significant bleeding events.


Results: A total of 300 patients were included for analysis, with 150 patients in each dosing group. There were no statistically significant differences in baseline characteristics, and the majority of traumatic injury diagnoses were attributed to gunshot wounds. Incidence of VTE was similar between the pre and post groups (4% vs 2%, p = 0.501). The median time to enoxaparin initiation was 11.8 hours pre and 9.25 hours post implementation (p = 0.672). Incidence of clinically significant bleeding was similar between groups (1.3% vs 2%, p = 0.462).


Conclusions: Implementation of a higher dose of prophylactic enoxaparin showed no increase in incidence of clinical VTE or clinically significant bleeding compared to standard dosing strategies. These findings, along with those of prior studies, suggest the safety and efficacy of an increased dosing regimen, but further research is needed to assess the impact of these updated guidelines.