What question did this study set out to answer?

To characterize peak antifactor Xa levels and evaluate bleeding complications in morbidly obese patients receiving treatment doses of enoxaparin.

November 1, 2015Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy

Monitoring Enoxaparin with Antifactor Xa Levels in Obese Patients

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Population

99 morbidly obese patients who received at least three doses of the standard treatment dosage of enoxaparin

Design

Cohort

Authors

YLYoung R. LeeThe University of Texas at Tyler JVJosé A. VegaBowie State University HDHanh‐Nhi Q. Duong

Discussion

Member takes

Implication

Variable anti-Xa levels seen in morbidly obese patients on enoxaparin; hypothesis-generating and should not yet change practice.

Key Points

To characterize peak antifactor Xa levels and evaluate bleeding complications in morbidly obese patients receiving treatment doses of enoxaparin.
Retrospective cohort study at a community hospital evaluating N=99 morbidly obese patients (BMI > 40 kg/m² or body weight > 150 kg) receiving standard treatment doses of enoxaparin.
Steady-state peak antifactor Xa levels were measured 4 hours after administration of the third dose, using a therapeutic range of 0.5–1.1 units/mL.
Univariate regression analysis was conducted to assess correlations between baseline clinical characteristics and antifactor Xa levels.
Peak antifactor Xa levels were supratherapeutic in 50.5% of patients (50/99), within the therapeutic range (0.5–1.1 units/mL) in 35.4% (35/99), and subtherapeutic in 14.1% (14/99).
Major bleeding occurred in 0% of patients (0/99) across the cohort.
A significant negative correlation occurred between peak antifactor Xa levels and serum creatinine concentration (r = -0.262, p = 0.009).

Structured PICO

Population

99 morbidly obese patients (BMI > 40 kg/m2 or total body weight > 150 kg) who received at least three doses of the standard treatment dosage of enoxaparin

Intervention

Enoxaparin standard treatment dosage (at least three doses)

Outcome

Proportion of patients whose steady-state antifactor Xa peak values were in the therapeutic (0.5-1.1 units/ml), subtherapeutic, and supratherapeutic rangessurrogate

Standard treatment dosing of enoxaparin in morbidly obese patients frequently results in supratherapeutic antifactor Xa levels, suggesting a need for routine monitoring.

Cite This Study

Lee et al. (2015) studied this question.

synapsesocial.com/papers/6a728f7035aa2c282ce3514e https://doi.org/10.1002/phar.1658

Topics

Anticoagulation in AF

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Monitoring Enoxaparin with Antifactor Xa Levels in Obese Patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Monitoring Enoxaparin with Antifactor Xa Levels in Obese Patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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