Anti-factor Xa levels in patients undergoing laparoscopic sleeve gastrectomy: 2 different dosing regimens of enoxaparin

Gelikas, Shaul; Eldar, Shai Meron; Lahat, Guy

doi:10.1016/j.soard.2017.07.027

Cited by 12 publications

(12 citation statements)

References 23 publications

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“…Only Gelikas et al reported that females had significantly higher aFXa levels than men. As in our study, the female population of Gelikas et al was significantly lighter, which led them to conclude that this difference might be due to different weights [12], but they lacked proof of this claim. By matching the males and females of our study cohort, we indeed showed that there was no difference in aFXa levels between males and females with obesity.…”

Section: Discussioncontrasting

confidence: 67%

“…Many previous studies have tested different dosages of enoxaparin for patients with obesity [ 12 – 14 , 19 , 23 , 24 ]. Most of them focused on the optimal dosage regimen while not taking sex into account.…”

Section: Discussionmentioning

confidence: 99%

“…By matching the males and females of our study cohort, we indeed showed that there was no difference in aFXa levels between males and females with obesity. This is a very important finding, considering that the “best dosage” for patients with obesity has yet to be determined [ 12 – 14 ]. Future studies should now be able to determine the best dosing strategy without having to account for the different sexes.…”

Section: Discussionmentioning

confidence: 99%

“…Data regarding height, weight, BMI, waist circumference, comorbidities, type of surgery, and standard laboratory parameters were collected. We use a BMI-based enoxaparin dosage as our in-house standard, since the optimal dosage of enoxaparin for patients with obesity has yet to be determined [12][13][14]. Patients were administered enoxaparin (Clexane®/ Sanofi-Aventis) subcutaneously twice daily as thromboprophylaxis based on their BMI.…”

Section: Patient Selectionmentioning

confidence: 99%

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Comparison of Anti-factor Xa Levels in Female and Male Patients with Obesity After Enoxaparin Application for Thromboprophylaxis

et al. 2022

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Purpose Venous thromboembolic events (VTEs) are common complications after bariatric surgery, and enoxaparin is commonly used to prevent VTEs. The risk for VTEs is sex-specific. Whether enoxaparin application results in similar anti-factor Xa activities (aFXa) in males and females with obesity remains to be determined. We investigated whether our dosage regimen of enoxaparin resulted in similar serum aFXa levels in female and male patients undergoing bariatric surgery. Materials and Methods We administered enoxaparin twice daily in patients undergoing bariatric surgery. Patients with a body mass index (BMI) > 60 kg/m2 (n = 11) received 60 mg enoxaparin (group 2), and patients with lower BMI (n = 86) received 40 mg per dose (group 1). Peak aFXa levels were measured 3 days after surgery. The primary outcome was the aFXa level. As a secondary outcome, we detected VTEs and major bleeding events and explored the possible influencing factors of aFXa. Results Women had higher aFXa than men, but after matching for anthropometric values, the two groups were similar (females: 0.17 ± 0.08 U/ml; males: 0.18 ± 0.08 U/ml). Linear regression revealed a moderate relationship between weight and aFXa levels. The 3-month follow-up was attended by 94.9%, at which one patient had pulmonary embolism. Conclusion Individual enoxaparin dosage regimens for men and women do not seem to be required. Weight-based dosing regimen seems to be a more reasonable choice. Graphical abstract

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

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Comparison of Anti-factor Xa Levels in Female and Male Patients with Obesity After Enoxaparin Application for Thromboprophylaxis

et al. 2022

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“…Overall, the five prospective cohort studies on enoxaparin included a low number of obese patients (n ¼ 39-223), and, if any, only a few cases of VTE and bleedings were observed. [9][10][11][12][13] Therefore, their conclusions mainly relied on biochemical measures. Three studies, collectively, seemed to agree on the notion that 40 mg once or twice daily is associated with a relatively low proportion of patients reaching the biochemical target, especially in patients > 150 kg.…”

Section: Prophylaxis In Bariatric Surgerymentioning

confidence: 99%

Dosage of Anticoagulants in Obesity: Recommendations Based on a Systematic Review

Abildgaard

Madsen

Hvas

2020

Semin Thromb Hemost

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Anticoagulants are frequently used as thromboprophylaxis and in patients with atrial fibrillation (AF) or venous thromboembolism (VTE). While obesity rates are reaching epidemic proportions worldwide, the optimal dosage for obese patients has not been established for most anticoagulants, including low-molecular-weight heparin (LMWH), non–vitamin K antagonist oral anticoagulants (NOAC), and pentasaccharides (fondaparinux). The aim of the present systematic review was to summarize the current knowledge and provide recommendations on dosage of LMWH, NOAC, and fondaparinux in obese patients (body mass index [BMI] ≥ 30 kg/m2 or body weight ≥ 100 kg). Based on a systematic search in PubMed and Embase, a total of 72 studies were identified. For thromboprophylaxis with LMWH in bariatric surgery (n = 20 studies), enoxaparin 40 mg twice daily, dalteparin 5,000 IE twice daily, or tinzaparin 75 IU/kg once daily should be considered for patients with BMI ≥ 40 kg/m2. For thromboprophylaxis with LMWH in nonbariatric surgery and in medical inpatients (n = 8 studies), enoxaparin 0.5 mg/kg once or twice daily or tinzaparin 75 IU/kg once daily may be considered in obese patients. For treatment with LMWH (n = 18 studies), a reduced weight-based dose of enoxaparin 0.8 mg/kg twice daily should be considered in patients with BMI ≥ 40 kg/m2, and no dose capping of dalteparin and tinzaparin should be applied for body weight < 140 kg. As regards NOAC, rivaroxaban, apixaban, or dabigatran may be used as thromboprophylaxis in patients with BMI < 40 kg/m2 (n = 4 studies), whereas rivaroxaban and apixaban may be administered to obese patients with VTE or AF, including BMI > 40 kg/m2, at standard fixed-dose (n = 20 studies). The limited available evidence on fondaparinux (n = 3 studies) indicated that the treatment dose should be increased to 10 mg once daily in patients weighing > 100 kg.

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Prophylactic Use of Enoxaparin in Adolescents During Bariatric Surgery—a Prospective Clinical Study

et al. 2019

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Anti-factor Xa levels in patients undergoing laparoscopic sleeve gastrectomy: 2 different dosing regimens of enoxaparin

Cited by 12 publications

References 23 publications

Comparison of Anti-factor Xa Levels in Female and Male Patients with Obesity After Enoxaparin Application for Thromboprophylaxis

Comparison of Anti-factor Xa Levels in Female and Male Patients with Obesity After Enoxaparin Application for Thromboprophylaxis

Dosage of Anticoagulants in Obesity: Recommendations Based on a Systematic Review

Prophylactic Use of Enoxaparin in Adolescents During Bariatric Surgery—a Prospective Clinical Study

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