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Episode 25: Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial | RAPM Focus

<!DOCTYPE html> <html data-head-attrs="" lang="en"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <meta name="mobile-web-app-capable" content="yes"> <meta name="apple-mobile-web-app-status-bar-style" content="black"> <meta name="theme-color" content="#ffffff"> <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/twitter-bootstrap/5.0.1/css/bootstrap.min.css" integrity="sha512-Ez0cGzNzHR1tYAv56860NLspgUGuQw16GiOOp/I2LuTmpSK9xDXlgJz3XN4cnpXWDmkNBKXR/VDMTCnAaEooxA==" crossorigin="anonymous" referrerpolicy="no-referrer" /> <link rel="preconnect" href="https://fonts.googleapis.com"> <link rel="preconnect" href="https://fonts.gstatic.com" crossorigin> <script type="module" crossorigin src="https://pbcdn1.podbean.com/fs1/user-site-dist/assets/index.56f02cba.js"></script> <link rel="modulepreload" href="https://pbcdn1.podbean.com/fs1/user-site-dist/assets/vendor.926efe0f.js"> <link rel="stylesheet" href="https://pbcdn1.podbean.com/fs1/user-site-dist/assets/index.b464827f.css"> <link rel="manifest" href="/user-site/manifest.webmanifest" crossorigin="use-credentials"><title>Episode 25: Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial | RAPM Focus</title><link rel="icon" href="https://mcdn.podbean.com/mf/web/s4uak85bxyg6wgx8/RAPM-Focus.jpeg"><link rel="apple-touch-icon" href="https://mcdn.podbean.com/mf/web/s4uak85bxyg6wgx8/RAPM-Focus.jpeg"><meta property="og:title" content="Episode 25: Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial | RAPM Focus"><meta property="og:image" content="https://d2bwo9zemjwxh5.cloudfront.net/image-logo/16464604/RAPM-Focus_1200x628.jpg?s=a9ea38bb59dd5084b0c268cd7d40c94e&amp;e=jpeg"><meta property="og:type" content="article"><meta property="og:url" content="https://rapmfocusbmj.podbean.com/e/episode-25evaluating-residual-anti-xalevels-following-discontinuation-oftreatmentdoseenoxaparin-inpatients-presentingfor-elective-surgerya-prospective/"><meta property="og:description" content="In this episode of RAPM Focus, Dr. Brian Sites sits down with Daryl Henshaw, MD, and Christopher Edwards, MD, to discuss “Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial,” first published in June 2023. Dr. Daryl Henshaw completed his medical school residency in regional anesthesia and acute pain fellowship training at Wake Forest. He is the associate vice chair of clinical operations at Atrium Health Wake Forest Baptist, the section head of regional anesthesia and acute pain management, and the medical director of acute pain services. Dr. Christopher Edwards is a graduate of Louisiana State University Health Sciences at Wake Forest for both anesthesia and fellowship training in RAPM. He is the medical director for regional anesthesia and acute pain. Dr. Henshaw and colleagues performed a prospective observational trial, where they asked the question if current guidelines to hold full anti-coagulation dose of Lovenox for 24 hours before surgery resulted in adequate anti-Xa level activity to support the performance of neuraxial or deep anesthetic type nerve block procedures. Consenting patients on treatment-dose enoxaparin were randomized to either a 24-hour group (last dose at 07:00 the day prior to surgery) or a 36-hour group (last dose at 19:00 2 days prior to surgery). On arrival for surgery, blood samples were obtained to assess residual anti-Xa level activity and renal function. The primary outcome was residual anti-Xa level activity following the last treatment dose of enoxaparin. Incorporating all patients, linear regression modeling was performed to predict the timepoint at which the level of anti-Xa activity reliably fell below 0.2 IU/mL. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline."><meta name="description" content="In this episode of RAPM Focus, Dr. Brian Sites sits down with Daryl Henshaw, MD, and Christopher Edwards, MD, to discuss “Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial,” first published in June 2023. Dr. Daryl Henshaw completed his medical school residency in regional anesthesia and acute pain fellowship training at Wake Forest. He is the associate vice chair of clinical operations at Atrium Health Wake Forest Baptist, the section head of regional anesthesia and acute pain management, and the medical director of acute pain services. Dr. Christopher Edwards is a graduate of Louisiana State University Health Sciences at Wake Forest for both anesthesia and fellowship training in RAPM. He is the medical director for regional anesthesia and acute pain. Dr. Henshaw and colleagues performed a prospective observational trial, where they asked the question if current guidelines to hold full anti-coagulation dose of Lovenox for 24 hours before surgery resulted in adequate anti-Xa level activity to support the performance of neuraxial or deep anesthetic type nerve block procedures. Consenting patients on treatment-dose enoxaparin were randomized to either a 24-hour group (last dose at 07:00 the day prior to surgery) or a 36-hour group (last dose at 19:00 2 days prior to surgery). On arrival for surgery, blood samples were obtained to assess residual anti-Xa level activity and renal function. The primary outcome was residual anti-Xa level activity following the last treatment dose of enoxaparin. Incorporating all patients, linear regression modeling was performed to predict the timepoint at which the level of anti-Xa activity reliably fell below 0.2 IU/mL. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline."><meta name="twitter:card" content="player"><meta name="twitter:site" content="@podbeancom"><meta name="twitter:url" content="https://rapmfocusbmj.podbean.com/e/episode-25evaluating-residual-anti-xalevels-following-discontinuation-oftreatmentdoseenoxaparin-inpatients-presentingfor-elective-surgerya-prospective/"><meta name="twitter:title" content="Episode 25: Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial | RAPM Focus"><meta name="twitter:description" content="In this episode of RAPM Focus, Dr. Brian Sites sits down with Daryl Henshaw, MD, and Christopher Edwards, MD, to discuss “Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial,” first published in June 2023. Dr. Daryl Henshaw completed his medical school residency in regional anesthesia and acute pain fellowship training at Wake Forest. He is the associate vice chair of clinical operations at Atrium Health Wake Forest Baptist, the section head of regional anesthesia and acute pain management, and the medical director of acute pain services. Dr. Christopher Edwards is a graduate of Louisiana State University Health Sciences at Wake Forest for both anesthesia and fellowship training in RAPM. He is the medical director for regional anesthesia and acute pain. Dr. Henshaw and colleagues performed a prospective observational trial, where they asked the question if current guidelines to hold full anti-coagulation dose of Lovenox for 24 hours before surgery resulted in adequate anti-Xa level activity to support the performance of neuraxial or deep anesthetic type nerve block procedures. Consenting patients on treatment-dose enoxaparin were randomized to either a 24-hour group (last dose at 07:00 the day prior to surgery) or a 36-hour group (last dose at 19:00 2 days prior to surgery). On arrival for surgery, blood samples were obtained to assess residual anti-Xa level activity and renal function. The primary outcome was residual anti-Xa level activity following the last treatment dose of enoxaparin. Incorporating all patients, linear regression modeling was performed to predict the timepoint at which the level of anti-Xa activity reliably fell below 0.2 IU/mL. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline."><meta name="twitter:image" content="https://d2bwo9zemjwxh5.cloudfront.net/image-logo/16464604/RAPM-Focus_1200x628.jpg?s=a9ea38bb59dd5084b0c268cd7d40c94e&amp;e=jpeg"><meta name="twitter:player" content="https://www.podbean.com/player-v2/?i=xm686-15e30dd&amp;square=1"><meta name="twitter:player:width" content="420"><meta name="twitter:player:height" content="420"><meta http-equiv="Content-Type" content="text/html; charset=UTF-8"><meta http-equiv="Content-Language" content="en-us"><meta name="generator" content="Podbean 3.2"><meta name="viewport" content="width=device-width, user-scalable=no, initial-scale=1.0, minimum-scale=1.0, maximum-scale=1.0"><meta name="author" content="PodBean Development"><meta name="Copyright" content="PodBean"><meta name="HandheldFriendly" content="True"><meta name="MobileOptimized" content="MobileOptimized"><meta name="robots" content="all"><meta name="twitter:app:id:googleplay" content="com.podbean.app.generic"><meta name="twitter:app:id:ipad" content="1484287462"><meta name="twitter:app:id:iphone" content="1484287462"><meta name="twitter:app:name:googleplay" content="Podbean Biz Podcast App"><meta name="twitter:app:name:ipad" content="Podbean Biz Podcast App"><meta name="twitter:app:name:iphone" content="Podbean Biz Podcast App"><script type="application/ld+json">{"@context":"https://schema.org/","@type":"PodcastEpisode","url":"/e/episode-25evaluating-residual-anti-xalevels-following-discontinuation-oftreatmentdoseenoxaparin-inpatients-presentingfor-elective-surgerya-prospective/","name":"Episode 25: Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial","datePublished":"2024-03-25","description":"In this episode of RAPM Focus, Dr. Brian Sites sits down with Daryl Henshaw, MD, and Christopher Edwards, MD, to discuss “Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial,” first published in June 2023.\nDr. Daryl Henshaw completed his medical school residency in regional anesthesia and acute pain fellowship training at Wake Forest. He is the associate vice chair of clinical operations at Atrium Health Wake Forest Baptist, the section head of regional anesthesia and acute pain management, and the medical director of acute pain services.\nDr. Christopher Edwards is a graduate of Louisiana State University Health Sciences at Wake Forest for both anesthesia and fellowship training in RAPM. He is the medical director for regional anesthesia and acute pain.\nDr. Henshaw and colleagues performed a prospective observational trial, where they asked the question if current guidelines to hold full anti-coagulation dose of Lovenox for 24 hours before surgery resulted in adequate anti-Xa level activity to support the performance of neuraxial or deep anesthetic type nerve block procedures. Consenting patients on treatment-dose enoxaparin were randomized to either a 24-hour group (last dose at 07:00 the day prior to surgery) or a 36-hour group (last dose at 19:00 2 days prior to surgery). On arrival for surgery, blood samples were obtained to assess residual anti-Xa level activity and renal function. The primary outcome was residual anti-Xa level activity following the last treatment dose of enoxaparin. Incorporating all patients, linear regression modeling was performed to predict the timepoint at which the level of anti-Xa activity reliably fell below 0.2 IU/mL.\n*The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. 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play-button me-4" type="button" title="Play Episode 25: Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial"><svg t="1622017593702" class="icon icon-play text-white" fill="currentColor" viewbox="0 0 1024 1024" version="1.1" xmlns="http://www.w3.org/2000/svg" p-id="12170" width="30" height="30"><path d="M844.704269 475.730473L222.284513 116.380385a43.342807 43.342807 0 0 0-65.025048 37.548353v718.692951a43.335582 43.335582 0 0 0 65.025048 37.541128l622.412531-359.342864a43.357257 43.357257 0 0 0 0.007225-75.08948z" fill="" p-id="12171"></path></svg></button><div><p class="e-date pt-1 mb-2">Monday Mar 25, 2024</p><h1 class="card-title e-title text-three-line fs-50">Episode 25: Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial</h1><div 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1-.488.876l-6.718-3.12a2.5 2.5 0 1 1 0-3.256l6.718-3.12A2.5 2.5 0 0 1 11 2.5zm-8.5 4a1.5 1.5 0 1 0 0 3 1.5 1.5 0 0 0 0-3zm11 5.5a1.5 1.5 0 1 0 0 3 1.5 1.5 0 0 0 0-3z"></path></svg><span class="text-gray item-name col-auto">Share</span></button></li></ul></div></div></div></div></div></div></div><!--]--><div class="episode-detail-bottom container"><div class="episode-content"><div class="border-0 d-flex list"><div class="card-body mt-5 ps-0"><p class="e-description card-text mb-5 text-dark"><p>In this episode of RAPM Focus, Dr. Brian Sites sits down with Daryl Henshaw, MD, and Christopher Edwards, MD, to discuss “Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial,” first published in <a href="https://rapm.bmj.com/content/early/2023/06/05/rapm-2023-104571">June 2023</a>.</p> <p>Dr. Daryl Henshaw completed his medical school residency in regional anesthesia and acute pain fellowship training at Wake Forest. He is the associate vice chair of clinical operations at Atrium Health Wake Forest Baptist, the section head of regional anesthesia and acute pain management, and the medical director of acute pain services.</p> <p>Dr. Christopher Edwards is a graduate of Louisiana State University Health Sciences at Wake Forest for both anesthesia and fellowship training in RAPM. He is the medical director for regional anesthesia and acute pain.</p> <p>Dr. Henshaw and colleagues performed a prospective observational trial, where they asked the question if current guidelines to hold full anti-coagulation dose of Lovenox for 24 hours before surgery resulted in adequate anti-Xa level activity to support the performance of neuraxial or deep anesthetic type nerve block procedures. Consenting patients on treatment-dose enoxaparin were randomized to either a 24-hour group (last dose at 07:00 the day prior to surgery) or a 36-hour group (last dose at 19:00 2 days prior to surgery). On arrival for surgery, blood samples were obtained to assess residual anti-Xa level activity and renal function. The primary outcome was residual anti-Xa level activity following the last treatment dose of enoxaparin. Incorporating all patients, linear regression modeling was performed to predict the timepoint at which the level of anti-Xa activity reliably fell below 0.2 IU/mL.</p> <p>*The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.</p> <p>Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.</p></p></div></div></div><div class="pb-2"><!----></div></div></div><!--[--><footer class="cc-footer2 footer mt-auto" style="--footerFontColor:#ffffff;--footerBackgroundColor:#000000;"><div class="container text-center"><ul class="row gx-4 social-icon-content list-unstyled d-flex justify-content-center mb-0"><!----><!----><!----><!----><!----></ul><div class="right-content"><p class="mb-0 pt-3">Copyright 2023 All rights reserved.</p><!----></div></div></footer><div class="after-footer"></div><!----><!--]--></div></div><!----><!----><!----><div style="display:none;">Version: 20240731</div></div></div> <script>window.__INITIAL_STATE__="{\"store\":{\"baseInfo\":{\"podcastTitle\":\"RAPM Focus\",\"slug\":\"rapmfocusbmj\",\"podcastDescription\":\"RAPM Focus is devoted to exploring the provocative and impactful aspects of the research published in Regional Anesthesia & Pain Medicine (RAPM) - rapm.bmj.com. Authors are joined by Editor-in-Chief, Dr. Brian Sites, and other members of the RAPM Editorial Board to discuss and debate the findings that matter most for clinicians, patients, and policy makers. Topical coverage includes all aspects of acute, perioperative, transitional, and chronic pain medicine.\\n\\nAt RAPM, we believe well-done pain medicine improves health and well-being. 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Consenting patients on treatment-dose enoxaparin were randomized to either a 24-hour group (last dose at 07:00 the day prior to surgery) or a 36-hour group (last dose at 19:00 2 days prior to surgery). On arrival for surgery, blood samples were obtained to assess residual anti-Xa level activity and renal function. The primary outcome was residual anti-Xa level activity following the last treatment dose of enoxaparin. Incorporating all patients, linear regression modeling was performed to predict the timepoint at which the level of anti-Xa activity reliably fell below 0.2 IU\u002FmL.\u003C\u002Fp\u003E\\n\u003Cp\u003E*The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. 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