{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:11:19Z","timestamp":1788667879172,"version":"build-2803163510"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Contemporary trauma guidelines support higher initial enoxaparin dosing for adult trauma patients, as standard dosing (30\u00a0mg twice daily [BID]) frequently fails to achieve target anticoagulant activity. While anti-factor Xa (anti-Xa) monitoring guides dose adjustments, real-world implementation of follow-up monitoring remains variable. This study evaluated anti-Xa target attainment, dose escalation practices, and completion of follow-up monitoring in high-risk trauma patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study at a Level I trauma center included adult trauma patients (April 2022-October 2023) receiving enoxaparin venous thromboembolism prophylaxis who underwent at least one anti-Xa measurement. Demographics, Injury Severity Score (ISS), dosing changes, and repeat monitoring frequencies were analyzed. This study evaluated real-world clinical practice and was not designed to compare dosing strategies or assess a protocolized intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 244 patients (median ISS 22; 43% with BMI &gt;40\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), 80% initially received standard dosing (30\u00a0mg BID). Only 42% achieved target prophylactic anti-Xa levels (0.2\u2013&lt;0.5 IU\/mL). Of those on standard dosing, 34% required escalation, with the mean adjusted dose approaching 40\u00a0mg BID. While 68% of patients who underwent repeat testing after dose escalation successfully achieved target levels, repeat monitoring was completed in only 22% of all adjusted patients. Venous thromboembolism occurred in 5%, and bleeding in 7%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Standard enoxaparin dosing frequently fails high-risk trauma patients, supporting contemporary higher-dose guidelines. However, a critical implementation gap persists; while clinicians recognize subtherapeutic levels and escalate doses, follow-up anti-Xa monitoring is inconsistently performed. Standardized tracking protocols and automated electronic triggers are required to close the loop in anti-Xa pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261486938","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:26:01Z","timestamp":1788539161000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Why 30\u00a0mg Twice Daily Fails: Anti-Factor Xa Monitoring and the Persistent Dosing Gap in High-Risk Trauma Patients"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9716-3778","authenticated-orcid":false,"given":"Khalid","family":"Almahmoud","sequence":"first","affiliation":[{"name":"Allegheny General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilana","family":"Porges","sequence":"additional","affiliation":[{"name":"Allegheny General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunice","family":"Chung","sequence":"additional","affiliation":[{"name":"Stony Brook Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Philp","sequence":"additional","affiliation":[{"name":"Allegheny General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Murdock","sequence":"additional","affiliation":[{"name":"Allegheny General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12959-023-00555-7"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14450"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-017-0315-0"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/1060028016683970"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000003854"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000003580"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph23010059"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-019-01208-z"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200207000-00032"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.07.055"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/000313481808400672"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182788fa7"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000004170"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/505373"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000197354.69796.bd"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.51893\/2021.1.OA9"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1530\/EOR-22-0054"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2904"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-022-02333-9"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002830"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2025.12.032"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199401000-00002"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2023-001287"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.18773\/austprescr.2017.053"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2016.1120718"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.4103\/jrpp.jrpp_11_25"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.3390\/pharmaceutics9030036"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2021.02.034"},{"issue":"1","key":"e_1_3_4_30_2","first-page":"e21215","article-title":"Complications associated with administration of post-operative weight-based enoxaparin in orthopaedic trauma patients","volume":"14","author":"Booth M","year":"2022","unstructured":"Booth M, Hamilton O, Bramer M, Brooks W, Niemann M. Complications associated with administration of post-operative weight-based enoxaparin in orthopaedic trauma patients. 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