Correlation of missed doses of enoxaparin with increased incidence of deep vein thrombosis in trauma and general surgery patients

JAMA Surg. 2014 Apr;149(4):365-70. doi: 10.1001/jamasurg.2013.3963.


Importance: Enoxaparin sodium is widely used for deep vein thrombosis (DVT) prophylaxis, yet DVT rates remain high in the trauma and general surgery populations. Missed doses during hospitalization are common.

Objective: To determine if missed doses of enoxaparin correlate with DVT formation.

Design, setting, and participants: Data were prospectively collected among 202 trauma and general surgery patients admitted to a level I trauma center.

Main outcomes and measures: Deep vein thrombosis screening was performed using a rigorous standardized protocol.

Results: The overall incidence of DVT was 15.8%. In total, 58.9% of patients missed at least 1 dose of enoxaparin. The DVTs occurred in 23.5% of patients who missed at least 1 dose and in 4.8% of patients who did not (P < .01). On univariate analysis, the need for mechanical ventilation (71.8% vs 44.1%), the performance of more than 1 operation (59.3% vs 40.0%), and male sex (75% vs 56%) were associated with DVT formation (P < .05 for all). A bivariate logistic regression was then performed, which revealed age 50 years or older and interrupted enoxaparin therapy as the only independent risk factors for DVT formation. The DVT rate did not differ between trauma and general surgery populations or in patients receiving once-daily vs twice-daily dosing regimens.

Conclusions and relevance: Interrupted enoxaparin therapy and age 50 years or older are associated with DVT formation among trauma and general surgery patients. Missed doses occur commonly and are the only identified risk factor for DVT that can be ameliorated by physicians. Efforts to minimize interrupted enoxaparin prophylaxis in patients at risk for DVT should be optimized.

MeSH terms

  • Anticoagulants / administration & dosage
  • Dose-Response Relationship, Drug
  • Enoxaparin / administration & dosage*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Oregon / epidemiology
  • Prospective Studies
  • Risk Factors
  • Surgical Procedures, Operative / adverse effects*
  • Trauma Centers*
  • Treatment Outcome
  • Venous Thrombosis / epidemiology
  • Venous Thrombosis / etiology
  • Venous Thrombosis / prevention & control*
  • Wounds and Injuries / complications*


  • Anticoagulants
  • Enoxaparin