Prospective Evaluation of Weight-Based Prophylactic Enoxaparin Dosing in Critically Ill Trauma Patients: Adequacy of AntiXa Levels Is Improved.

Venous thromboembolism (VTE) is a leading cause of death in multisystem trauma patients; the importance of VTE prevention is well recognized. Presently, standard dose enoxaparin (30 mg BID) is used as chemical prophylaxis, regardless of weight or physiologic status. However, evidence suggests decreased bioavailability of enoxaparin in critically ill patients. Therefore, we hypothesized that a weight-based enoxaparin dosing regimen would provide more adequate prophylaxis (as indicated by antifactor Xa levels) for patients in our trauma intensive care unit (TICU).These data were prospectively collected in TICU patients admitted over a 5-month period given twice daily 0.6 mg/kg enoxaparin (actual body weight). Patients were compared with a historical cohort receiving standard dosing. Anti-Xa levels were collected at 11.5 hours (trough, goal ≥ 0.1 IU/mL) after each evening administration. Patient demographics, admission weight, dose, and daily anti-Xa levels were recorded. Patients with renal insufficiency or brain, spine, or spinal cord injury were excluded. Data were collected from 26 patients in the standard-dose group and 37 in the weight-based group. Sixty-four trough anti-Xa measurements were taken in the standard dose group and 74 collected in the weight-based group. Evaluating only levels measured after the third dose, the change in dosing of enoxaparin from 30 to 0.6 mg/kg resulted in an increased percentage of patients with goal antifactor Xa levels from 8 per cent to 61 per cent (P < 0.0001). Examining all troughs, the change in dose resulted in an increase in patients with a goal anti-Xa level from 19 to 59 per cent (P < 0.0001). Weight-based dosing of enoxaparin in trauma ICU patients yields superior results with respect to adequate anti-Xa levels when compared with standard dosing. These findings suggest that weight-based dosing may provide superior VTE prophylaxis in TICU patients. Evaluation of the effects of this dosing paradigm on actual VTE rate is ongoing at our institution.

Improvement in treatment adherence with a 3-day course of fluocinonide cream 0.1% for atopic dermatitis.

Variations in adherence may cause variations in treatment outcomes with topical corticosteroid therapy for atopic dermatitis. An intensive short course of outpatient treatment may promote good adherence and provide a high level of efficacy. The purpose of this study was to assess the efficacy, tolerability, and adherence to short-term treatment with fluocinonide cream 0.1% in the treatment of atopic dermatitis. Twenty participants with mild to severe atopic dermatitis were instructed to use fluocinonide cream 0.1% twice daily for 3 consecutive days for a total of 6 doses. Disease severity was assessed at baseline, day 3, day 7, and day 14. Electronic monitoring was used to measure adherence to treatment. Median adherence to treatment over the 3-day period was 100%. By day 14, the median visual analog scale (VAS) of pruritus and eczema area and severity index (EASI) scores improved from baseline by 79% and 76%, respectively. By the end of the study period, 11 participants had investigator global assessment (IGA) scores of clear or almost clear. The absolute degree of improvement was proportional to baseline disease severity. Short-term treatment with fluocinonide cream 0.1% for atopic dermatitis was well-tolerated and resulted in significant disease improvement (P < .001). Participants were highly adherent to the 3-day treatment regimen. Efforts to improve adherence may be valuable approaches for treating recalcitrant atopic dermatitis.