Thrombelastography (TEG®) based dosing of enoxaparin for thromboprophylaxis: a prospective randomized trial
Marty Schreiber, MD

The risk of developing a blood clot occurs in up to 60% of all critical care patients. Many times Lovenox is given to patients who are at a higher risk of developing clots in their legs or lungs. Recent data suggest that a standard dose of Lovenox may not fully prevent the development of these clots, especially in critically ill or obese patients. Routine enoxaparin dosing can also result in bleeding complications. Thrombelastography (TEG) can be used to measure how blood clots.

The purposes of this study are to: a) learn if the TEG can better guide physicians in prescribing an effective dose of Lovenox compared to standard doses in preventing blood clots from developing in the legs and lungs, b) compare the development of blood clots in patients receiving the standard dose to patients receiving a TEG guided dose of Lovenox, and c) determine if TEG guided dosing results in decreased bleeding complications compared to standard dosing.

Enrolled patients will be randomized to receive the standard dose ordered by their doctor or to have their dose modified based on the TEG results. Patients will have up to 1 teaspoon of blood drawn as often as daily or as infrequently as two times a week until the medicine is stopped or until they are discharged from the hospital. Researchers will compare incidence of blood clots formed and bleeding complications between the two groups of patients to determine if TEG modified dosing relates to a lower rate of blood clots in critically ill patients.