Evaluation of a novel blood volume-based enoxaparin dosing guideline for venous thromboembolism prophylaxis in trauma patients.

PURPOSE: Fixed-dose and body mass index (BMI)-based enoxaparin regimens provide inadequate venous thromboembolism (VTE) prophylaxis for many trauma patients. The purpose of this study was to evaluate the effectiveness of a novel blood volume (BV)-based enoxaparin guideline vs a historical BMI-based guideline for VTE prophylaxis in trauma patients. METHODS: This was a retrospective pre/post study completed at a large academic level 1 trauma center. All adult trauma patients admitted from October through December 2019 and August through October 2020 who received prophylactic enoxaparin per guideline were included. The BV dosing was as follows: patients with a BV of 3 to 4.9 L received enoxaparin 30 mg every 12 hours, those with a BV of 5 to 6.9 L received 40 mg every 12 hours, and those with a BV of ≥7 L received 60 mg every 12 hours. The primary outcome was the percentage of patients who attained a target anti-factor Xa (anti-Xa) postdosing level at the first steady-state assessment (0.2 to 0.5 IU/mL). RESULTS: A total of 241 patients (99 for the BMI group and 142 for the BV group) were included. The study groups had a median age of 38 vs 42 years, a mean BMI of 27.4 vs 27.7 kg/m2, and a mean BV of 5.1 vs 5.1 L, respectively. A total of 63 patients (62.6%) in the BMI group attained target anti-Xa levels compared to 115 patients (81%) in the BV group (P = 0.008). In multivariate regression, the BV-based guideline was the only variable associated with attainment of target anti-Xa levels (adjusted odds ratio, 2.02; P = 0.01). Clinically relevant bleeding and VTE rates were similar between the groups. CONCLUSION: Dosing prophylactic enoxaparin using a BV-based dosing guideline significantly increased attainment of target anti-Xa levels.

Evaluation of anti-factor Xa concentrations using a body mass index-based enoxaparin dosing protocol for venous thromboembolism prophylaxis in trauma patients.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a body mass index (BMI)-based enoxaparin prophylaxis dosing protocol at achieving target anti-factor Xa (anti-Xa) concentrations in the trauma population. METHODS: This retrospective chart review evaluated anti-Xa concentrations in adult trauma patients who received prophylactic enoxaparin over a three-month period. The primary outcome was the percentage of patients that achieved target anti-Xa concentrations after ≥3 doses of enoxaparin. Secondary outcomes included correlations of anti-Xa concentrations with enoxaparin dose per BMI, total body weight (TBW), and estimated blood volume (EBV). The prevalence of clinically relevant bleeding and venous thromboembolism was also recorded. Multivariable logistic regression was used to identify associated variables for target anti-Xa concentration attainment. RESULTS: Ninety-nine consecutive patients were included in the study. Included patients were predominately male (69.7%) and Black (50.5%) with a mean age of 44.1 years. Target anti-Xa concentrations were achieved in 62.6% of patients. Anti-Xa concentrations were moderately correlated with enoxaparin dose per EBV (ρ = 0.57), followed by dose per TBW (ρ = 0.46), and dose per BMI (ρ = 0.20). Multivariable logistic regression demonstrated that categorization of enoxaparin dose per EBV and per TBW were the only statistically significant predictors of reaching target anti-Xa concentrations (p = <0.001). CONCLUSIONS: In adult trauma patients, the rate of achieving target anti-Xa concentrations remains suboptimal and provides room for further improvement. Enoxaparin dose per EBV was more closely correlated with anti-Xa concentrations when compared to TBW and BMI. Dosing per EBV and TBW was the only variables associated with reaching target anti-Xa concentrations within the study. Further investigation is warranted to elucidate optimal EBV- and TBW-based dosing regimens.

Study of the solid-matrix phosphorescence properties of a heterocyclic aromatic amine and the heat capacities of glucose glasses as the temperature decreases.

The heat capacities were obtained from 294 to 133 K for four glucose-glass systems. Two of the glasses were prepared from crystalline glucose. One of the glasses contained the heavy-atom salt NaI and the other glass did not contain NaI. The other two glasses were similar, but they were prepared from glucose melts. Correlations were developed between the solid-matrix phosphorescence (SMP) lifetimes and intensities of 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) in the glucose glasses and the heat capacities of the glucose sugar glasses as the temperature was lowered. Several plots of reciprocal SMP lifetime versus reciprocal temperature and reciprocal SMP lifetime versus reciprocal heat capacity were compared. Also, the reciprocal SMP intensity versus reciprocal temperature plots were compared with the corresponding reciprocal SMP intensity versus reciprocal heat capacity plots. In addition, basic photo-physical equations were used to develop relationships among the lifetime data, the intensity data, and the heat capacity data. The heat capacity data and SMP lifetime data, obtained as the temperature was lowered, were discussed in relationship to low-frequency vibrational modes and beta-relaxation phenomena in the glucose glasses. The discussion of these phenomena offered explanations for some of the loss of the excited triplet-state energy of PhIP in the glucose sugar glasses.

Solid-matrix luminescence of heterocyclic aromatic amines in several new sugar-glass systems.

Several new sugar glasses were investigated for their potential in solid-matrix luminescence. Both solid-matrix fluorescence (SMF) and solid-matrix phosphorescence (SMP) properties were obtained, and two heterocyclic aromatic amines were employed as model compounds. In addition to glucose glasses, which were investigated previously, fructose, ribose, xylose, galactose, maltose, and glucose with poly(acrylic acid) (PAA) were studied. Detailed experimental conditions were obtained for each sugar-glass system. In addition, NaI was investigated as a heavy-atom salt in the sugar-glass systems to enhance the SMP of the heterocyclic aromatic amines. The SMF intensity was the strongest in maltose and glucose with PAA for 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) and in maltose for 2-amino-9H-pyrido[2,3-b]indole (AalphaC). The largest SMP signals for PhIP with and without NaI were acquired in glucose with PAA. For AalphaC with NaI, the strongest SMP signal was obtained in maltose. Limits of detection were obtained for PhIP in the several sugar-glass systems, and the lowest limit of detection was 0.04pmol/mg of PhIP in maltose with NaI present. An extensive study was carried out using both SMF and SMP to determine if neutral and/or protonated species of PhIP and AalphaC were in the sugar-glass systems. General guidelines such as glass transition temperature and solubility are discussed for selecting a sugar glass as a solid matrix.

Self and other obedience estimates: biases and moderators.

The authors conducted 2 studies regarding behavior perceptions of "self" and "typical other" in hypothetical replications of S. Milgram's (1963) obedience experiment. In Study 1, participants' knowledge about Milgram's actual results was manipulated. Regardless of knowledge, results demonstrated several specific social and perceptual biases (e.g., the self-other bias; J. D. Brown, 1986), in addition to several general, fundamental lessons of social psychology (e.g., the perseverance of lay dispositionism). Study 2 was designed to explore the possibility that participants' own academic interests and worldview could influence the biases explicated in Study 1. The authors assessed perceptions of both criminal-justice majors and non-criminal-justice majors regarding their perceptions of behaviors of self and typical other. The criminal-justice students' self-other obedience estimates were significantly higher than those of the non-criminal-justice students. Further, the self-other discrepancy for criminal-justice students was significantly smaller than the difference reported by non-criminal-justice majors, suggesting that the criminal-justice students demonstrated the self-other bias significantly less than non-criminal-justice students in this context. The findings indicate that specific social-perceptual biases may have been moderated by career interest and worldview.