Evaluation and Pharmacokinetics of Treatment Dose Enoxaparin in Hospitalized Patients With Morbid Obesity

Thompson-Moore, Nathaniel; Wanat, Matthew A.; Putney, David; Liebl, Phuong H. Nguyen; Chandler, Wayne L.; Muntz, James E.

doi:10.1177/1076029614568713

Cited by 28 publications

(44 citation statements)

References 27 publications

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“…These findings suggest that initial doses calculated using actual body weight may be greater than what is needed, which is consistent with some previously published reports . Therapeutic or supra‐therapeutic anti‐Xa levels were achieved in 74% of the RD group.…”

Section: Resultssupporting

confidence: 91%

“…Thus, enoxaparin is used off label in children. Second, obesity can affect the pharmacokinetics of enoxaparin, although it is unclear if the net effects warrant dose modifications . Third, the therapeutic ranges recommended by the College of American Pathologists have not been validated in clinical trials .…”

Section: Introductionmentioning

confidence: 99%

“…For example, PE in adolescents is rarely fatal and likely secondary to fewer comorbidities in the adolescent population . In addition, adult dose‐reduction strategies such as dose‐capping may not apply for an obese adolescent who weighs less . Because of these differences, data from obese adolescents is necessary and should not be extrapolated from trials designed for obese adults.…”

Section: Introductionmentioning

confidence: 99%

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Reduced dosing of enoxaparin for venous thromboembolism in overweight and obese adolescents: a single institution retrospective review

Hoffman

Braunreiter

2017

Research and Practice in Thrombosis and Haemostasis

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Essentials Data is scarce on enoxaparin dosing for obese adolescents with venous thromboembolism (VTE).Overweight and obese adolescents treated with reduced enoxaparin dose (RD) were reviewed.Initial enoxaparin doses calculated using actual body weight may be greater than what is needed.Trials are warranted to evaluate RD enoxaparin for overweight and obese adolescents with VTE. BackgroundThe global obesity epidemic has created new challenges, including venous thromboembolisms (VTE) in obese adolescents. The data on whether to reduce the dose of low‐molecular heparin in obese adults is conflicting, and information on adolescent patients is scarce.ObjectivesOur primary goal was to describe dosing, anti‐Xa levels, and outcomes of overweight and obese adolescents who received reduced doses of enoxaparin at the initiation of therapy. The secondary goal was to compare their outcomes to overweight and obese adolescents who received standard 1 mg/kg dosing to determine if future trials for dose reduction are warranted.Patients/MethodsWe performed a retrospective cohort study of overweight and obese patients between the ages of 12 and 18 years old diagnosed with VTE who were treated with reduced dosing (RD) of enoxaparin, comparing their dosing, anti‐Xa levels, and outcomes to overweight and obese adolescents who received standard dosing (SD).Results RD patients (n=19) achieved therapeutic mean initial anti‐Xa levels that were similar to SD patients (n=11). Of the RD patients, 53% did not require dose adjustments during treatment. Two RD patients had thrombus progression. A total of 25 patients ultimately completed therapy with RD.ConclusionsFuture trials are warranted to evaluate the efficacy and safety of reduced dosing of enoxaparin to treat overweight and obese adolescents with VTE.

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Section: Resultssupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reduced dosing of enoxaparin for venous thromboembolism in overweight and obese adolescents: a single institution retrospective review

Hoffman

Braunreiter

2017

Research and Practice in Thrombosis and Haemostasis

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“…The enoxaparin dosing regimens observed in this study were reflective of those seen in other studies. 9 – 11 In the present study, the majority of participants whether prescribed enoxaparin for prophylaxis or treatment indications and whether they were prescribed capping or noncapping dosing regimens did not achieve the target therapeutic anti-Xa level. The results of the present study indicate that other factors besides patients’ weight affect anti-Xa levels.…”

Section: Discussionmentioning

confidence: 69%

“…Previously published studies did not agree on specific enoxaparin dosing regimens that will result in therapeutic anti-Xa levels for prophylaxis or treatment indications in obese patients. 9 , 11 , 14 – 17 For example, a prospective study sequentially assigned medically ill and extremely obese patients who were prescribed enoxaparin for prophylaxis indications into 3 groups. The first group received a fixed dose of enoxaparin of 40 mg/d, the second group received 0.4 mg/kg/d, and the third group received high-dose enoxaparin of 0.5 mg/kg/d.…”

Section: Discussionmentioning

confidence: 99%

Anti-factor Xa levels in obese patients receiving enoxaparin for treatment and prophylaxis indications

Tahaineh¹,

Edaily²,

Gharaibeh³

2018

CPAA

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ObjectivesTo evaluate the degree of anticoagulation achieved with different enoxaparin dosing regimens used in obese and morbidly obese patients in a hospital setting in Jordan.MethodsAll obese adult patients who were prescribed enoxaparin for various indications were invited to participate in the study. The anti-factor Xa (anti-Xa) level was checked once after 4–6 hours of the third or fourth dose of enoxaparin (at steady state). Patients were followed daily to evaluate drug efficacy and safety through their hospital course.ResultsEnoxaparin daily dose used for prophylaxis indications ranged from 0.3 to 0.85 mg/kg and from 0.31 to 2.25 mg/kg in case of certain treatment indications. Most participants who received enoxaparin for treatment indications (76.9%) were on capping dosing regimens, which was <1 mg/kg twice daily. On the other hand, most patients (88.5%) who received enoxaparin for prophylaxis indications were on a fixed 40 mg/d dose. Among the 52 patients who completed the study, 19 patients (36.5%) had therapeutic anti-Xa levels. The results showed no statistically significant associations between regimens that were used and achieving therapeutic anti-Xa level (p>0.05). No bleeding events or thrombocytopenia were noticed, and there was one case of recurrent thrombosis.ConclusionEnoxaparin dosing regimens that were used for obese patients varied based on prescribing physicians. Regardless of the regimen used, the majority of participants had nontherapeutic anti-Xa. Individualized dosing regimens based on anti-Xa levels are warranted for obese patients on enoxaparin.

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Assessment of BMI and Venous Thromboembolism Rates in Patients on Standard Chemoprophylaxis Regimens After Undergoing Free Tissue Transfer to the Head and Neck

Saadoun

Bengür

Moroni

et al. 2022

JAMA Otolaryngol Head Neck Surg

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ImportanceVenous thromboembolism (VTE) is a severe complication after free tissue transfer to the head and neck (H&amp;N). Enoxaparin 30 mg twice daily (BID) is a common regimen for chemoprophylaxis. However, differences in enoxaparin metabolism based on body weight may influence its efficacy and safety profile.ObjectiveTo assess the association between BMI and postoperative VTE and hematoma rates in patients treated with prophylactic enoxaparin 30 mg BID.Design, Setting, and ParticipantsThis was a retrospective review of a prospectively collected cohort from 2012 to 2022. Postoperative VTE, hematoma, and free flap pedicle thrombosis were recorded within 30 days of index surgery. The setting was a tertiary academic referral center. Participants included patients undergoing H&amp;N reconstruction with free flaps that received fixed-dose subcutaneous enoxaparin 30 mg BID postoperatively. Statistical analysis was conducted from April to May 2022.Main Outcomes and MeasuresOutcomes include incidence of VTE, hematoma, and flap pedicle thrombosis events within 30 days of the surgery. Univariate and multivariable regression models were used to evaluate associations between BMI and other patient factors with these outcomes.ResultsAmong the 765 patients included, 262 (34.24%) were female; mean (SD) age was 60.85 (12.64) years; and mean (SD) BMI was 26.36 (6.29). The rates of VTE and hematoma in the cohort were 3.92% (30 patients) and 5.09% (39 patients), respectively. After adjusting for patient factors, BMI was the only factor associated with VTE (OR, 1.07; 95% CI, 1.015-1.129). Obesity (BMI &gt;30) was associated with increased odds of VTE (OR, 2.782; 95% CI, 1.197-6.564). Hematoma was not associated with BMI (OR, 0.988; 95% CI, 0.937-1.041). Caprini score of at least 9 was not associated with VTE (OR, 1.259; 95% CI, 0.428-3.701).Conclusions and RelevanceThis cohort study found that obesity was associated with an increased risk of VTE in patients after microvascular H&amp;N reconstruction and while on standard postoperative chemoprophylaxis regimens. This association may suggest insufficient VTE prophylaxis in this group and a potential indication for weight-based dosing.

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Evaluation and Pharmacokinetics of Treatment Dose Enoxaparin in Hospitalized Patients With Morbid Obesity

Abstract: Patients with morbid obesity required less than the recommended 1 mg/kg enoxaparin dose to achieve therapeutic peak anti-Xa levels; therefore, initiation with lower dosages is prudent and anti-Xa monitoring should guide dosage adjustments.

Cited by 28 publications

References 27 publications

Reduced dosing of enoxaparin for venous thromboembolism in overweight and obese adolescents: a single institution retrospective review

Reduced dosing of enoxaparin for venous thromboembolism in overweight and obese adolescents: a single institution retrospective review

Anti-factor Xa levels in obese patients receiving enoxaparin for treatment and prophylaxis indications

Assessment of BMI and Venous Thromboembolism Rates in Patients on Standard Chemoprophylaxis Regimens After Undergoing Free Tissue Transfer to the Head and Neck

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