2026 Eastern States Conference

Title: Enoxaparin for trauma-related venous thromboembolism prophylaxis: Bleeding risk with vs. without monitoring in a rural academic medical center 
Authors: Lauren Wagner, PharmD, MBA; Alena Thannikal, PharmD, BCPS, BCCCP; Michelle Budzyn, PharmD, BCPS 
Learning Objective: Evaluate trauma-related bleeding complications with or without a pharmacist-driven monitoring protocol 
Self-assessment question: True or False: In trauma patients receiving anti-Xa monitoring, the rate of clinically significant bleeding is decreased
Background/objective: Pharmacist‑driven monitoring and dose adjustment may optimize enoxaparin prophylaxis, but rates of bleeding in rural trauma patients receiving enoxaparin for VTE prophylaxis remains understudied.  This study evaluates bleeding outcomes with or without pharmacist‑driven monitoring. 
Methods: This single‑center retrospective cohort study examined adult trauma patients who received enoxaparin for trauma‑related VTE prophylaxis from 9/1/24–1/1/25, compared those with pharmacist‑driven monitoring to those without it. Included criteria were trauma patients ≥18 years who received enoxaparin during hospitalization at a Geisinger Medical Center facility. Patients were excluded if they were on hemodialysis, pregnant, had known enoxaparin hypersensitivity, or anticoagulated immediately before prophylaxis. The primary outcome was the rate of clinically significant bleeding in monitored versus non‑monitored patients and assess factors influencing complications, including traumatic brain injury (TBI), spinal cord injury, pelvic fractures, advanced age, and low body weight. Secondary outcomes include incidence of any thrombotic event. The primary outcome was analyzed using a chi-square test with associated factors evaluated through a multivariable logistic regression model in a forest plot. The secondary outcome was analyzed using Fisher’s exact test. Statistical significance was defined as α = 0.05 for all analyses. 
Results: Out of 673 patients, 324 were included in the analysis, 203 in the monitored group, and 121 in the non-monitored group. Incidence of significant bleeding occurred in 17.7% in the monitored group and 11.6% in the non-monitored group (RR 1.53, p = 0.137). Two variables, advanced age (OR 6.56, p = 0.114) and monitored/non-monitored (OR 7.93, p = 0.083), were identified to have an increased odd of bleeding. Incidence of new thrombotic events occurred in 0.5% in the monitored group and 2.5% in the non-monitored group (RR 0.20, p = 0.149).
Conclusion: The results of this study showed no statistical significance in bleeding events nor new thrombotic events between the two groups. Therefore, Anti-Xa level monitoring may be beneficial in high-risk patient populations such as advanced age, traumatic brain injury (TBI), or pelvic fractures. However, larger, more refined studies will be required to confirm these findings.