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Thrombelastography-Based Dosing of Enoxaparin for Thromboprophylaxis in Trauma and Surgical Patients: A Randomized Clinical Trial

Overview of attention for article published in JAMA Surgery, August 2016
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (93rd percentile)
  • Above-average Attention Score compared to outputs of the same age and source (64th percentile)

Mentioned by

news
3 news outlets
twitter
9 tweeters
facebook
1 Facebook page
googleplus
1 Google+ user

Citations

dimensions_citation
13 Dimensions

Readers on

mendeley
50 Mendeley
Title
Thrombelastography-Based Dosing of Enoxaparin for Thromboprophylaxis in Trauma and Surgical Patients: A Randomized Clinical Trial
Published in
JAMA Surgery, August 2016
DOI 10.1001/jamasurg.2016.2069
Pubmed ID
Authors

Christopher R. Connelly, Philbert Y. Van, Kyle D. Hart, Scott G. Louis, Kelly A. Fair, Anfin S. Erickson, Elizabeth A. Rick, Erika C. Simeon, Eileen M. Bulger, Saman Arbabi, John B. Holcomb, Laura J. Moore, Martin A. Schreiber, Connelly, Christopher R, Van, Philbert Y, Hart, Kyle D, Louis, Scott G, Fair, Kelly A, Erickson, Anfin S, Rick, Elizabeth A, Simeon, Erika C, Bulger, Eileen M, Arbabi, Saman, Holcomb, John B, Moore, Laura J, Schreiber, Martin A

Abstract

Prophylactic enoxaparin is used to prevent venous thromboembolism (VTE) in surgical and trauma patients. However, VTE remains an important source of morbidity and mortality, potentially exacerbated by antithrombin III or anti-Factor Xa deficiencies and missed enoxaparin doses. Recent data suggest that a difference in reaction time (time to initial fibrin formation) greater than 1 minute between heparinase and standard thrombelastogram (TEG) is associated with a decreased risk of VTE. To evaluate the effectiveness of TEG-adjusted prophylactic enoxaparin dosing among trauma and surgical patients. This randomized clinical trial, conducted from October 2012 to May 2015, compared standard dosing (30 mg twice daily) with TEG-adjusted enoxaparin dosing (35 mg twice daily) for 185 surgical and trauma patients screened for VTE at 3 level I trauma centers in the United States. The incidence of VTE, bleeding complications, anti-Factor Xa deficiency, and antithrombin III deficiency. Of the 185 trial participants, 89 were randomized to the control group (median age, 44.0 years; 55.1% male) and 96 to the intervention group (median age, 48.5 years; 74.0% male). Patients in the intervention group received a higher median enoxaparin dose than control patients (35 mg vs 30 mg twice daily; P < .001). Anti-Factor Xa levels in intervention patients were not higher than levels in control patients until day 6 (0.4 U/mL vs 0.21 U/mL; P < .001). Only 22 patients (11.9%) achieved a difference in reaction time greater than 1 minute, which was similar between the control and intervention groups (10.4% vs 13.5%; P = .68). The time to enoxaparin initiation was similar between the control and intervention groups (median [range] days, 1.0 [0.0-2.0] vs 1.0 [1.0-2.0]; P = .39), and the number of patients who missed at least 1 dose was also similar (43 [48.3%] vs 54 [56.3%]; P = .30). Rates of VTE (6 [6.7%] vs 6 [6.3%]; P > .99) were similar, but the difference in bleeding complications (5 [5.6%] vs 13 [13.5%]; P = .08) was not statistically significant. Antithrombin III and anti-Factor Xa deficiencies and hypercoaguable TEG parameters, including elevated coagulation index (>3), maximum amplitude (>74 mm), and G value (>12.4 dynes/cm2), were prevalent in both groups. Identified risk factors for VTE included older age (61.0 years vs 46.0 years; P = .04), higher body mass index (calculated as weight in kilograms divided by height in meters squared; 30.6 vs 27.1; P = .03), increased Acute Physiology and Chronic Health Evaluation II score (8.5 vs 7.0; P = .03), and increased percentage of missed doses per patient (14.8% vs 2.5%; P = .05). The incidence of VTE was low and similar between groups; however, few patients achieved a difference in reaction time greater than 1 minute. Antithrombin III deficiencies and hypercoaguable TEG parameters were prevalent among patients with VTE. Low VTE incidence may be due to an early time to enoxaparin initiation and an overall healthier and less severely injured study population than previously reported. clinicaltrials.gov Identifier: NCT00990236.

Twitter Demographics

The data shown below were collected from the profiles of 9 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 50 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 2%
Denmark 1 2%
Unknown 48 96%

Demographic breakdown

Readers by professional status Count As %
Student > Doctoral Student 9 18%
Researcher 9 18%
Student > Postgraduate 6 12%
Other 6 12%
Student > Bachelor 5 10%
Other 15 30%
Readers by discipline Count As %
Medicine and Dentistry 30 60%
Unspecified 5 10%
Agricultural and Biological Sciences 3 6%
Social Sciences 3 6%
Biochemistry, Genetics and Molecular Biology 2 4%
Other 7 14%

Attention Score in Context

This research output has an Altmetric Attention Score of 32. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 June 2017.
All research outputs
#377,153
of 11,342,318 outputs
Outputs from JAMA Surgery
#492
of 1,752 outputs
Outputs of similar age
#16,530
of 265,151 outputs
Outputs of similar age from JAMA Surgery
#32
of 90 outputs
Altmetric has tracked 11,342,318 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 96th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,752 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 39.3. This one has gotten more attention than average, scoring higher than 71% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 265,151 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 93% of its contemporaries.
We're also able to compare this research output to 90 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 64% of its contemporaries.