Using Anti-Xa Levels to Provide Efficient Care in Patients Post-Bariatric Procedure: A Quality Improvement Project

Abstract

Background: Post-bariatric procedure patients are at risk for complications, such as venous thromboembolisms (VTEs). To mitigate this risk, enoxaparin, an anticoagulant is given to patients directly following their surgical procedure. Despite the widespread practice, there is currently a lack of standardization on enoxaparin dosing and the timing of obtaining Anti-factor Xa assay (anti-Xa) to ensure proper dosing. Objective: The purpose of this pilot project was to standardize post-procedure protocol based on best practice evidence for enoxaparin dosing and optimal timing for checking anti-Xa levels in post-bariatric surgery patients. Setting: Community hospital, public practice Methods: Forty milligrams of enoxaparin was given post-procedure and patients began a regimen of two doses daily twelve hours apart. Anti-Xa levels were checked 3 to 5 hours after administering the second dose. Anti-Xa levels, post- procedure complications and length of stay were evaluated over a six-week timeframe. Results: A total of 22 patients were included in the project. The average anti-Xa level for this sample was 0.23, which is considered therapeutic. There were two post-op complications, which consisted of a splenic laceration and gastrointestinal bleed. Length of hospital stay went from 1.8 to 1.7 days. Three patient’s enoxaparin regimens were able to be adjusted due to their anti-Xa level not being therapeutic, which resulted in no post-op complications. Conclusions: This project’s intervention decreased length of hospital stay. By checking lab levels sooner, enoxaparin regimens can be adjusted to prevent complications. Additional data should be gathered to understand the effect on post-op complications and bleeding events.A five-year embargo was granted for this item