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  • Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: an infographic

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Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: an infographic
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  1. Daryl S Henshaw1,2,
  2. Eric S Schwenk3 and
  3. Rajnish K Gupta4
  1. 1 Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  2. 2 Atrium Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, North Carolina, USA
  3. 3 Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  4. 4 Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Dr Rajnish K Gupta, Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; raj.gupta{at}vumc.org

https://doi.org/10.1136/rapm-2023-104873

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    Summary

    Current guidelines from both the American and European societies recommend that treatment-dose enoxaparin should be held 24 hours prior to the performance of neuraxial or deep anesthetic procedures to reduce the chance of bleeding. In this prospective observational trial,1 blood samples evaluating for residual anti-Xa level activity and renal function were obtained from volunteer patients who were randomized into a 24-hour or 36-hour hold group. Linear regression modeling was used to predict the time point at which anti-Xa activity reliably fell below 0.2 IU/mL (the level below which is considered subtherapeutic for prophylactic anticoagulation). Based on the upper bounds of the 95% CI, patients reliably fell below 0.2 IU/mL at 31.5 hours. Women presenting under 24 hours from last dose were significantly less likely to have anti-Xa levels below 0.2 IU/mL than men. No other correlation was observed related to age, renal function, or sex. Based on these results, 24-hour hold time for treatment-dose enoxaparin may be inadequate for reliable safety during neuraxial and deep blocks.

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    Reference

    1. ↵
      2. Henshaw DS ,
      3. Edwards CJ ,
      4. Dobson SW , et al
      . Evaluating residual anti-Xa levels following discontinuation of treatment-dose Enoxaparin in patients presenting for elective surgery: a prospective observational trial. Reg Anesth Pain Med 2024;49:94–101. doi:10.1136/rapm-2023-104571
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    Footnotes

    • Twitter @ESchwenkMD, @dr_rajgupta

    • Contributors All authors contributed to the concept and design and editing of the infographic. DSH is the lead author of the original manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests RKG and ESS are co-associate editors for social media in Regional Anesthesia and Pain Medicine. ESS is an editor for Regional Anesthesia and Pain Medicine. RKG is a Director-at-Large for the American Society of Regional Anesthesia and Pain Medicine Board of Directors.

    • Provenance and peer review Commissioned; internally peer reviewed.

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