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Research Article Open Access

Enoxaparin Administration Times and Hospital Length of Stay in Venous Thromboembolism Treatment: A Retrospective Study

Abstract

Background and objectives: Variations in enoxaparin administration times after orders in Computerized Physician Order Entry (CPOE) can increase the risk for bleeding and Venous thromboembolism (VTE) episodes and consequently increase hospital length of (LOS). Because of limited studies, the objective of the proposed retrospective cohort study was to evaluate the association of variations enoxaparin administration times and the hospital LOS.

Methods: Data were extracted from the study hospital’s pharmacy order system and electronic medical records. Adult inpatient aged 18-87 years at a Northeast US hospital (from June 2013-June 2015) who had received at least two treatment doses of enoxaparin for VTE were identified. Patient characteristics, enoxaparin administration time differences (between order and first dose (<=2, >2 h), and between first and second dose (<18, 18-24, and >=25 h)) and hospital LOS days were collected.

Results: Of 275 patients, 134, 79 and 62 had DVT, PE, and both, respectively. The majority of the 275 patients received first enoxaparin dose after 2 h from order (>2 h, 58%, 160/275 vs. <=2 h, 41%, 115/275). About 33%, 61%, 5% patients received the second dose within 18 h, 18 to 24 h, and beyond 25 or more hours, respectively, after having received the first dose of enoxaparin. However, hospital LOS did not differ between the patient groups by first or second enoxaparin dose administration timings.

Conclusion: Although the variations in enoxaparin administration timing were significant, hospital LOS did not significantly correlate with enoxaparin administration time differences. However, there was a not significant trend toward patients receiving delayed first dose beyond 2 h and earlier second doses within 18 h of the first dose which had a times of the first dose from order entry and second dose from the first dose could increase the risk of DVT, PE or both that warrant further attention of hospital providers, policy makers, and future researchers. With the new CPOE system implementation shortly, steps need to be taken to improve documentation adverse events and optimize administration timing of medications in hospitals.

Dana Huettenmoser#, Kyulim Lee#, Jayashri Sankaranarayanan*, Nick Tessier

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