Anti-Xa Activity After Enoxaparin Prophylaxis In Hospitalized Patients Weighing Less Than Fifty-Five Kilograms

Rojas, Luis; Aizman, Andrés; Ernst, Daniël; Acuña, M.P.; Moya, P.; Mellado, Rosemarie; Cerdá, Jaime

doi:10.1016/j.thromres.2013.10.005

Cited by 25 publications

(46 citation statements)

References 33 publications

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“…In this study, aFXa levels were not associated with age, gender, BMI, actual body weight, or CrCl. Other investigators have similarly found no correlation between aFXa and weight or BMI, whereas an inverse relationship between aFXa and weight or BMI has been identified in some studies . The possible correlation between renal function and aFXa levels should not be ruled out as the majority of patients in this study had normal CrCl.…”

Section: Discussioncontrasting

confidence: 50%

“…This occurred even though a vast majority (94.3%) received enoxaparin VTE prophylaxis at doses below the widely accepted 40 mg daily, with a median dose of 30 mg daily or approximately 0.6 mg/kg/day. A prospective trial evaluated adult patients weighing < 55 kg who received the standard fixed enoxaparin VTE prophylaxis dose of 40 mg daily and found that 60.7% of aFXa levels exceeded target values with the proportion further increasing to 85% above goal in patients who weighed < 45 kg . This illustrates the plausibility of weight‐based dosing in low‐weight patients.…”

Section: Discussionmentioning

confidence: 98%

“…Multiple references have defined target ranges as either 0.2–0.4 unit/ml or 0.2–0.6 unit/ml . We chose a range of 0.2–0.5 unit/ml, which is consistent with the trial that evaluated enoxaparin 40 mg daily in low‐weight patients along with a review on aFXa monitoring . Several studies utilized an aFXa goal of 0.2–0.4 unit/ml .…”

Section: Discussionmentioning

confidence: 99%

“…This study was a retrospective cohort of adult patients at least 18 years of age admitted to Loma Linda University Medical Center (LLUMC) from its implementation of Epic Systems Corporation Electronic Health Record from January 2008 through February 2017. Patients were included if they were low weight, defined as having an actual body weight < 55 kg on admission . Additionally, all included patients must have received at least one dose of enoxaparin for VTE prophylaxis with an aFXa level drawn after the dose.…”

Section: Methodsmentioning

confidence: 99%

“…Literature regarding whether there is a correlation between peak aFXa levels and body weight is conflicting . It has been shown that weight‐based dosing of enoxaparin is needed to achieve goal peak aFXa levels in obese patients and some studies suggest dosing enoxaparin at 0.5 mg/kg/day for VTE prophylaxis .…”

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confidence: 99%

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Enoxaparin Thromboprophylaxis Dosing and Anti–Factor Xa Levels in Low‐Weight Patients

et al. 2019

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Introduction Enoxaparin is a widely used anticoagulant to prevent venous thromboembolism (VTE). A fixed dose is recommended for VTE prophylaxis. However, fixed prophylactic doses of enoxaparin in low‐weight patients may be close to the weight‐based dosing recommended for VTE treatment. Objective To evaluate peak anti–factor Xa (aFXa) levels in low‐weight patients receiving enoxaparin for VTE prophylaxis. Methods Retrospective cohort of adult patients weighing < 55 kg who were hospitalized at Loma Linda University Medical Center between January 2008 and February 2017. All patients received enoxaparin for VTE prophylaxis with a peak aFXa level drawn. The primary endpoint was the proportion of patients achieving peak aFXa levels within the goal range of 0.2–0.5 unit/ml. Results Of 35 patients receiving enoxaparin for VTE prophylaxis with an appropriately timed peak aFXa level, 74% achieved goal peak aFXa levels and the median daily dose of enoxaparin was 30 mg. The mean weight was approximately 44 kg. No significant correlations between aFXa level and body mass index or body weight were found. Conclusion A lower dose of enoxaparin may be reasonable in low‐weight patients for VTE prophylaxis. There appears to be no safety concerns with reduced enoxaparin dosing in low‐weight patients. More robust data are needed to confirm these findings.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Enoxaparin Thromboprophylaxis Dosing and Anti–Factor Xa Levels in Low‐Weight Patients

et al. 2019

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Rivaroxaban versus nadroparin for thromboprophylaxis following thoracic surgery for lung cancer: A randomized, noninferiority trial

et al. 2023

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The benefit of rivaroxaban in thromboprophylaxis after oncologic lung surgery remains unknown. To evaluate the efficacy and safety of rivaroxaban, patients who underwent thoracic surgery for lung cancer were enrolled, and randomly assigned to rivaroxaban or nadroparin groups in a 1:1 ratio; anticoagulants were initiated 12–24 h after surgery and continued until discharge. Four hundred participants were required according to a noninferiority margin of 2%, assuming venous thromboembolism (VTE) occurrence rates of 6.0% and 12.6% for patients in the rivaroxaban and nadroparin groups, respectively. The primary efficacy outcome was any VTE during the treatment and 30‐day follow‐up periods. The safety outcome was any on‐treatment bleeding event. Finally, 403 patients were randomized (intention‐to‐treat [ITT] population), with 381 included in per‐protocol (PP) population. The primary efficacy outcomes occurred in 12.5% (25/200) of the rivaroxaban group and 17.7% (36/203) of the nadroparin group (absolute risk reduction, −5.2%; 95% confidence interval [CI], [−12.2–1.7]), indicating the noninferiority of rivaroxaban in ITT population. Sensitivity analysis was performed in the PP population and yielded similar results, confirming the noninferiority of rivaroxaban. In the safety analysis population, the incidence of any on‐treatment bleeding events did not differ significantly between the groups (12.2% for rivaroxaban vs. 7.0% for nadroparin; relative risk [RR], 1.9; 95% CI, [0.9–3.7]; p = .08), including major bleeding (9.7% vs. 6.5%; RR, 1.6 [95% CI, 0.9–3.7]; p = .24), and nonmajor bleeding (2.6% vs. 0.5%; RR, 5.2 [95% CI, 0.6–45.2]; p = .13). Rivaroxaban for thromboprophylaxis after oncologic lung surgery was shown to be noninferior to nadroparin.

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Enoxaparin dosing in Noonan syndrome: a case report

Tran

Tey

2020

Pharmacy Practice and Res

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BackgroundNoonan syndrome is a genetic condition that typically includes heart abnormalities and characteristic facial features. Various bleeding disorders have been associated with Noonan syndrome. Some affected individuals have excessive bruising, nosebleeds or prolonged bleeding following injury or surgery. This paper describes anti‐Factor Xa levels following excessive enoxaparin dosing in a male patient with Noonan syndrome.Clinical detailsA 24‐year‐old male (weighing 53 kg) presented under Orthopaedics for his elective three‐stage scoliosis surgery for kyphoscoliosis. The patient was usually on warfarin for a mechanical valve replacement. Bridging enoxaparin was prescribed (initially 1.5 mg/kg, SC, daily), but failure to reach therapeutic anti‐Factor Xa levels (highest level 0.44 units/mL) resulted in escalating enoxaparin doses (90 mg, SC, twice daily).OutcomesDespite a doses of up to 1.7 mg/kg enoxaparin twice daily, the patient did not reach therapeutic anti‐Factor Xa levels according to recommended reference ranges. The patient’s regular warfarin dose was restarted and the enoxaparin was ceased once his International Normalised Ratio was within the therapeutic range. The patient was transferred to a a rehabilitation facility 10 days after surgery.ConclusionMedication assay ranges may not always be an accurate point of reference, particularly when patients present with unusual comorbidities. As health care moves towards patient‐centred care, it is essential that individual patient parameters are considered when monitoring medication treatment plans.

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Anti-Xa Activity After Enoxaparin Prophylaxis In Hospitalized Patients Weighing Less Than Fifty-Five Kilograms

Cited by 25 publications

References 33 publications

Enoxaparin Thromboprophylaxis Dosing and Anti–Factor Xa Levels in Low‐Weight Patients

Enoxaparin Thromboprophylaxis Dosing and Anti–Factor Xa Levels in Low‐Weight Patients

Rivaroxaban versus nadroparin for thromboprophylaxis following thoracic surgery for lung cancer: A randomized, noninferiority trial

Enoxaparin dosing in Noonan syndrome: a case report

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