In 2011, trauma surgeon Dr. Martin Schreiber set out to answer a simple but important question. Should we give every injured patient the same fixed dose of blood-clot prevention, or should we tailor the dose to the person in front of us? His team proposed using a whole-blood test called thrombelastography, or TEG, to read a patient’s real-time clotting profile and adjust enoxaparin accordingly. The goal was straightforward. Prevent more clots in the highest-risk patients without causing more bleeding.
Reading through this work, what stands out is the mindset. Measure what matters. Translate data into decisions at the bedside. Build a pathway busy teams can actually use. That approach, more than any single tool, is what moved the field.
Here is why the study still deserves attention.
It named the problem clearly. After major injury, deep vein thrombosis and pulmonary embolism remain stubborn threats. Fixed dosing is easy to standardize, but not every body responds the same way. Patients with severe trauma, higher body mass, or prolonged immobilization are the likeliest to be underprotected on a one-size-fits-all regimen. Schreiber’s team challenged that habit.
It pushed precision into everyday care. The idea was not to chase numbers for their own sake. It was to use physiology to guide safer dosing. That spirit carried forward. Even though later summaries did not show consistent superiority for TEG-guided enoxaparin in prophylaxis, the field embraced the larger lesson. Today many centers start with higher, weight-aware doses and confirm protection with anti-Xa levels in the patients most likely to be subtherapeutic. Different instrument. Same destination.
It improved how teams communicate. Trauma care is collaborative. Surgeons, intensivists, pharmacists, and nurses need a shared language. Saying “this patient has not reached a prophylactic anti-Xa target” is clearer and more actionable than “this patient seems at risk.” The study helped normalize that kind of practical, measurable target.
It made outcomes the priority. Convenience is not an endpoint. Avoiding clots means fewer scans, fewer interventions, shorter stays, and less long-term harm. Even modest gains matter when multiplied across a trauma service.
So where are we now? In 2025, guidelines and hospital playbooks align around early prophylaxis when bleeding risk is controlled, weight-based starts for many adults, and targeted anti-Xa monitoring in higher-risk cohorts. Typical pathways begin at 40 mg enoxaparin twice daily for most adults outside of brain and spine injury, use 30 mg twice daily with careful reassessment for those populations, and escalate by weight with pharmacist-driven titration. TEG remains valuable in resuscitation and transfusion decisions, where a whole-blood view shines, but routine clot-prevention dosing has largely shifted to tools that are easier to standardize and audit.
Why should people learn about this project now? Because it marks a turning point in how we think about prevention in trauma. It shows how a field can move from a blunt default to a tuned approach without losing speed at the bedside. It also shows how research can succeed even when the original instrument does not become the everyday solution. The win is the principle that survived. Dose the patient, not the protocol.
If you work in trauma, critical care, or any fast-moving service, the takeaway is practical. Measure exposure. Set explicit targets. Adjust in small, safe steps. If you are a patient or caregiver, the message is reassuring. Modern trauma teams do not rely on a single fixed dose and hope for the best. They check, confirm, and individualize.
By that time, Dr Schreiber was serving as chief of trauma, critical care, and acute care surgery at OHSU and as a professor of surgery. His background spans both civilian and military medicine. As a U S Army reservist, he deployed to Iraq and Afghanistan and served as the Joint Theater Trauma System Director, a role centered on turning evidence into daily practice in austere settings. At OHSU, he led a trauma research laboratory with long-standing federal support, focused on hemostasis, resuscitation, and the body’s response to injury. His work has a consistent theme. Measure what matters, translate data into decisions at the bedside, and build protocols that busy teams can use.
For patients with traumatic brain injury, consensus work favors earlier prophylaxis once imaging shows stability, since delays raise clot risk and many patients tolerate carefully timed starts without lesion progression. This approach continues to evolve with updated best practice guidance.
The practical benefits are easy to see. More patients reach protective exposure without increased bleeding risk. Fewer patients suffer preventable clots. Teams speak a common language about timing, targets, and risk. The emphasis on measurement has also strengthened related pathways, including protocols for early prophylaxis in stable traumatic brain injury, and for pharmacist-driven titration in the intensive care unit.
The 2011 study highlights an important pivot point. It asked teams to replace a blunt instrument with a tuned approach. In the years since, trauma programs have kept the same guiding idea while choosing the most reproducible tools. Many centers still use TEG for resuscitation and transfusion choices, where whole blood viscoelastic testing offers insights that routine labs can miss. For clot prevention dosing, services now rely on weight and anti-Xa levels because those tools are easier to standardize, scale across units, and audit for safety and effectiveness.
That is the legacy of Dr. Schreiber’s study. A simple question that changed the conversation, and a mindset that continues to make care safer. You can also explore more of his work and interviews via this podcast.
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