ABSTRACT
INTRODUCTION: Enoxaparin is a widely used anticoagulant to prevent venous thromboembolism (VTE). A fixed dose is recommended for VTE prophylaxis. However, fixed prophylactic doses of enoxaparin in low-weight patients may be close to the weight-based dosing recommended for VTE treatment. OBJECTIVE: To evaluate peak anti-factor Xa (aFXa) levels in low-weight patients receiving enoxaparin for VTE prophylaxis. METHODS: Retrospective cohort of adult patients weighing < 55 kg who were hospitalized at Loma Linda University Medical Center between January 2008 and February 2017. All patients received enoxaparin for VTE prophylaxis with a peak aFXa level drawn. The primary endpoint was the proportion of patients achieving peak aFXa levels within the goal range of 0.2-0.5 unit/ml. RESULTS: Of 35 patients receiving enoxaparin for VTE prophylaxis with an appropriately timed peak aFXa level, 74% achieved goal peak aFXa levels and the median daily dose of enoxaparin was 30 mg. The mean weight was approximately 44 kg. No significant correlations between aFXa level and body mass index or body weight were found. CONCLUSION: A lower dose of enoxaparin may be reasonable in low-weight patients for VTE prophylaxis. There appears to be no safety concerns with reduced enoxaparin dosing in low-weight patients. More robust data are needed to confirm these findings.
Subject(s)
Anticoagulants/administration & dosage , Enoxaparin/administration & dosage , Factor Xa Inhibitors/blood , Thinness/blood , Venous Thromboembolism/prevention & control , Anticoagulants/therapeutic use , Blood Coagulation Tests , Body Mass Index , Dose-Response Relationship, Drug , Drug Administration Schedule , Enoxaparin/therapeutic use , Female , Humans , Male , Middle Aged , Retrospective Studies , Venous Thromboembolism/bloodABSTRACT
BACKGROUND: This study sought to compare the spectrum of injuries and outcomes between off-road and on-road motorcyclists. METHODS: Demographic information, accident location, helmet use, anatomic injuries, physiologic data, length of stay, transfusions, operations, Injury Severity Scores, and determination of death were abstracted for a consecutive cohort of patients over a 5-year period. RESULTS: There were no significant differences between off-road motorcyclists (n = 376) and on-road motorcyclists (n = 371) in terms of helmet use, loss of consciousness, initial systolic blood pressure, initial Glasgow Coma Scale, initial Revised Trauma Score, or hand, wrist, forearm, arm, clavicle, foot, ankle, femur, pelvis, spinal, or head injuries. On-road motorcyclists were significantly more likely, however, to require transfusions (p < 0.025); sustain blunt chest, abdominal, or skin trauma; or die (p < 0.05). CONCLUSIONS: On-road motorcyclists are more likely to sustain blunt abdominal trauma, blunt chest trauma, skin trauma, and death than off-road motorcyclists.
Subject(s)
Accidents, Traffic/statistics & numerical data , Motorcycles , Off-Road Motor Vehicles , Trauma Centers/statistics & numerical data , Wounds and Injuries/classification , Adult , California/epidemiology , Female , Head Protective Devices , Humans , Injury Severity Score , Male , Retrospective Studies , Seasons , Wounds and Injuries/etiologyABSTRACT
Motorsports is the fastest growing professional sport in the United States. Each year approximately 14 drivers die, and many others are paralyzed or seriously injured. Although there is a common misconception that motorsports medicine is analogous to standard emergency or sports medicine, due to the unique racing environment a traditional approach to emergency medical services can be ineffective and may expose drivers, spectators, and medical personnel to great danger. This article is a general review of the evolving subspecialty of motorsports medicine.
