{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:46:18Z","timestamp":1782283578287,"version":"3.54.5"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>Patients undergoing surgery for traumatic spine injuries have a high risk of venous thromboembolism (VTE). Standard fixed or weight-based enoxaparin regimens may leave some patients below prophylactic anti-factor Xa (anti-Xa) target ranges. Whether anti-Xa-guided enoxaparin dose adjustment can be implemented while maintaining acceptable observed bleeding outcomes has not been studied specifically in postoperative spine trauma patients. This study evaluates anti-Xa target attainment, symptomatic VTE, and safety outcomes after anti-Xa-guided enoxaparin titration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study of adults (\u226518 years old) who underwent operative treatment for traumatic spine injuries at a Level I trauma center. All patients received weight-based enoxaparin starting 24\u2005h postoperatively (30\u2005mg every 12\u2005h if &amp;lt;90\u2005kg, 40\u2005mg every 12\u2005h if \u226590\u2005kg) plus mechanical VTE prophylaxis and early mobilization. In the anti-Xa cohort, levels were obtained 4\u2005h after the third dose (target 0.2\u20130.4\u2005IU\/mL) and doses were adjusted by 10\u2005mg if outside this range. A comparison cohort received the same initial dosing without anti-Xa monitoring. The primary outcome was symptomatic postoperative VTE. Secondary outcomes included bleeding requiring transfusion, spinal epidural hematoma, hospital length of stay, and ambulation at discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 354 patients were included (170 anti-Xa; 184 fixed dose). Symptomatic VTE was rare and similar between groups (1.1% vs. 1.6%). No postoperative epidural hematomas occurred. In the anti-Xa cohort, 28% required dose escalation and 7% required more than one adjustment. In exploratory adjusted analyses, bleeding requiring transfusion and length of stay did not differ between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Weight-based enoxaparin with anti-Xa-guided titration was feasible after spine trauma surgery and identified a substantial subset of patients below the prespecified prophylactic anti-Xa target range. Protocol-based dose escalation was not associated with an observed increase in bleeding requiring transfusion, and no postoperative epidural hematomas occurred. Larger prospective studies are needed to determine whether improved anti-Xa target attainment translates into lower VTE rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1764591","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:46:33Z","timestamp":1782279993000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Weight-based, anti-Xa guided enoxaparin after spine trauma surgery: target attainment and safety in a retrospective cohort"],"prefix":"10.3389","volume":"13","author":[{"given":"Dallas L.","family":"Sheinberg","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, McGovern Medical School at UTHealth Houston","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Travis","family":"Johnston","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, McGovern Medical School at UTHealth Houston","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan T.","family":"O'Reilly","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, McGovern Medical School at UTHealth Houston","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Galan","family":"Castro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, McGovern Medical School at UTHealth Houston","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jawad R.","family":"Khazaal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, McGovern Medical School at UTHealth Houston","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph S.","family":"Withrow","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates","place":["Charlotte, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duncan J.","family":"Trimble","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, McGovern Medical School at UTHealth Houston","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankush","family":"Chandra","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, McGovern Medical School at UTHealth Houston","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony J.","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, McGovern Medical School at UTHealth Houston","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek S.","family":"Sheinberg","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine","place":["Miami, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Zaragoza","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, McGovern Medical School at UTHealth Houston","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, McGovern Medical School at UTHealth Houston","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, McGovern Medical School at UTHealth Houston","place":["Houston, TX, United 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