Key result
Weight-based dosing of enoxaparin in morbidly obese SICU patients achieved an initial mean anti-factor Xa level of 0.34 IU/mL, effectively reaching the appropriate prophylactic range.
Why the study?
Does a weight-based enoxaparin dosing protocol achieve appropriate prophylactic anti-factor Xa levels for VTE prevention in morbidly obese SICU patients?
Cohort (n=23)
No
Does a weight-based enoxaparin dosing protocol achieve appropriate prophylactic anti-factor Xa levels for VTE prevention in morbidly obese SICU patients?
A weight-based enoxaparin dosing protocol of 0.5 mg/kg every 12 hours effectively achieves prophylactic anti-factor Xa levels in morbidly obese SICU patients without significant adverse effects.
Answers are grounded in this paper and cite their sources.
Supports weight-based enoxaparin dosing in morbidly obese SICU patients; leaves open need for prospective validation.
BACKGROUND: Venous thromboembolism (VTE) is a serious health care issue that affects a large number of people. Few standards exist for delineating the optimal dosing strategy for VTE prevention in obese patients, especially in the setting of major surgery or trauma. OBJECTIVE: To document the efficacy of a surgical intensive care unit (SICU)-specific, weight-based dosing protocol of enoxaparin 0.5 mg/kg given subcutaneously every 12 hours for VTE prophylaxis in morbidly obese (defined as body mass index [BMI] ≥35 kg/m(2) or weight ≥150 kg) SICU patients, using peak anti-factor Xa levels to determine therapeutic endpoints. METHODS: Data were collected retrospectively in an academic, university-based SICU on 23 morbidly obese patients who received weight-based enoxaparin for VTE prophylaxis from December 1, 2008, through June 30, 2010. RESULTS: A weight-based dosage range of enoxaparin 50-120 mg twice daily (median 60) was given to 23 patients. The mean BMI was 46.4 kg/m(2). The initial mean anti-factor Xa level (measured after the third dose) was 0.34 IU/mL (range 0.20-0.59). Patients received an average of 18 doses. Two cases required an increase or decrease in dosage based on anti-factor Xa levels. Morbidity related to this dosing included a single event of minor endotracheal bleeding and a single deep vein thrombosis that was likely present prior to treatment. CONCLUSIONS: Weight-based dosing with enoxaparin in morbidly obese SICU patients was effective in achieving anti-factor Xa levels within the appropriate prophylactic range. This regimen reduced the rate of VTE below expected levels and no additional adverse effects were reported.
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Ludwig et al. (2011) conducted a cohort in Morbidly obese surgical intensive care unit patients requiring VTE prophylaxis (n=23). Weight-based enoxaparin was evaluated on Initial mean anti-factor Xa level (measured after the third dose). Weight-based dosing of enoxaparin in morbidly obese SICU patients achieved an initial mean anti-factor Xa level of 0.34 IU/mL, effectively reaching the appropriate prophylactic range.
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