Research on venous thromboembolism published in JAMA Surgery

By Roman Petrowski, Office of Communications

Dr. Jessica Cardenas -Venous thromboembolism Research
Jessica Cardenas, PhD

Recent research on venous thromboembolism from Jessica Cardenas, PhD, assistant professor in the Department of Surgery, has been published in JAMA Surgery.

The paper titled, “Association of Changes in Antithrombin Activity Over Time With Responsiveness to Enoxaparin Prophylaxis and Risk of Trauma-Related Venous Thromboembolism,” was co-written by Bryan Cotton, MD, professor of surgery; Laura Vincent, MS, RN; Michael Talanker, BS; Dakota Butler, BS, Xu Zhang, PhD, associate professor in the Department of Internal Medicine; Jeanette M. Podbielski, RN, Yao-Wei Wang, MD; Amber Chen-Goodspeed, BA; Selina L. Hernandez Gonzalez, BS; Erin Fox, PhD, associate professor of surgery; and Charles Wade, PhD, professor of surgery.

VTE is a common complication that causes the formation of dangerous blood clots in surgical patients and patients experiencing trauma. These blood clots are commonly treated with anticoagulants; however, the effectiveness of the treatment varies widely among patients.

“This research used a patient cohort study to demonstrate how transient changes in circulating levels of antithrombin, an important regulator of blood clotting, impact patient responsiveness to prophylactic anticoagulation and the association with VTE,” Cardenas said. “We used patient plasma samples to establish the dose-dependent effects of antithrombin therapy for improving responsiveness to pharmacologic anticoagulation and reducing the propensity of VTE.”

The group studied trauma surgical patients who were admitted to the hospital over a 13-month period. They collected samples over time to assess patient responsiveness to anticoagulants, circulating antithrombin levels, and other biomarkers associated with VTE, and then collected medical records of VTE and other outcomes.

Through the research, the team discovered longitudinal trends in antithrombin levels for patients who failed to respond to prophylactic anticoagulation leading to the development of VTE. They learned that in patients who were unresponsive to prophylactic anticoagulation, supplementation of antithrombin was most effective in the first 72 hours of being hospitalized, and did not increase the risk of bleeding.

The findings show that there is a need for a personalized approach to anticoagulant therapy for trauma and surgical patients with VTE and also provide a strategy for future testing of interventional trials.

“The results from this study have paved the way for obtaining funding for and development of a randomized interventional trial to examine the efficacy of antithrombin therapy for improving responsiveness to prophylactic anticoagulation and reducing the incidence of VTE,” Cardenas said. “We aim to begin enrollment of this multicenter trial in 2023.”