Rakhra S, et al. - In high-risk trauma patients admitted to the intensive care unit (ICU), researchers quantified the pharmacodynamic (PD) activity of daily subcutaneous (SC) enoxaparin as venous thromboembolism (VTE) prophylaxis. This investigation was carried out in the ICU of a state-wide major trauma referral centre. Participants in the study were adult patients admitted to the ICU with a high risk of VTE, as identified by at least one of the following: age > 40 years, prior VTE, spinal cord injury (SCI), traumatic brain injury (TBI), major venous injury, pelvic fractures, spinal fractures requiring treatment, severe lower limb injuries, and major surgery > 2 hours in duration. This prospective observational PD study involved 25 patients. In a cohort of high risk critically ill patients receiving daily SC enoxaparin as VTE chemoprophylaxis, a significant proportion of measured peak and trough anti-Xa plasma activity was inadequate. On this basis, further systemic dose optimisation research appears to be needed in this patient population. There have been no major complications of haemorrhage.