Weight-based dosing for low-molecular-weight heparin administration to achieve optimal venous thromboembolism prophylaxis in trauma patients: a systematic review and meta-analysis.

Abstract

Purpose: Venous thromboembolism (VTE) remains a major cause of morbidity in trauma patients. Enoxaparin, a low-molecular-weight heparin (LMWH), is widely used for VTE prevention; however, the optimal dosing strategy has not been established. This meta-analysis provides the most comprehensive comparison to date of weight-based (WB) versus fixed-dose (FD) enoxaparin regimens for achieving effective prophylaxis in trauma patients.

Methods: PubMed, Embase, and the Web of Science were searched, yielding 653 studies, of which 29 met the inclusion criteria. Systematic reviews, database studies, preclinical studies, and meta-analyses were excluded. The primary outcomes were the proportions of patients achieving prophylactic anti-factor Xa (anti-Xa) levels. Secondary outcomes included the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and bleeding events.

Results: A total of 4,183 patients in the FD group and 563 patients in the WB group were included. WB dosing achieved higher rates of initial prophylaxis (86.5% vs. 46.8%; odds ratio [OR], 7.27) and ever-prophylaxis (95.6% vs. 71.0%; OR, 8.87). WB dosing was associated with a lower incidence of DVT (1.8% vs. 5.0%; OR, 0.34) and a nonsignificant reduction in PE (0.4% vs. 1.2%; OR, 0.29). Bleeding events were more frequent with WB dosing (3.0% vs. 1.2%; OR, 2.26). Proportional meta-analysis similarly demonstrated higher pooled proportions of initial prophylaxis (89.5% vs. 42.7%, P<0.01) and ever-prophylaxis (95.7% vs. 77.6%, P<0.01) with WB dosing. WB strategies showed a lower pooled DVT incidence (1.7% vs. 3.4%, P=0.06) and significantly fewer PE events (0% vs. 0.6%, P<0.01). No significant difference in pooled bleeding rates was observed (1.9% vs. 0.6%, P=0.69).

Conclusions: Weight-based enoxaparin dosing was more effective than fixed dosing for achieving prophylactic anti-Xa levels and reducing DVT in trauma patients. Although bleeding events were more frequent in some cohorts, pooled analyses showed no significant increase in bleeding risk. Individualized assessment of bleeding risk remains essential.