What question did this study set out to answer?

To evaluate the enoxaparin dose required to achieve therapeutic peak antifactor Xa levels and assess the risk of supratherapeutic levels and bleeding in hospitalized patients with morbid obesity.

January 19, 2015Clinical and Applied Thrombosis/Hemostasis

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

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Why the study?

Does enoxaparin dose <0.95 mg/kg prevent supratherapeutic anti-Xa levels in hospitalized patients with morbid obesity compared to doses ≥0.95 mg/kg?

Population

41 hospitalized patients with morbid obesity prescribed treatment doses of enoxaparin >60 mg per day

Comparison

Enoxaparin dose <0.95 mg/kg vs Enoxaparin dose ≥0.95 mg/kg

Design

Cohort, masked

Authors

NTNathaniel Thompson‐MooreLegacy Health MWMatthew A. WanatUniversity of Houston DPDavid PutneyMethodist Hospital

Discussion

Member takes

Implication

Lower enoxaparin doses associated with fewer supratherapeutic anti-Xa levels in morbid obesity; hypothesis-generating and should not change practice without RCTs.

Key Points

To evaluate the enoxaparin dose required to achieve therapeutic peak antifactor Xa levels and assess the risk of supratherapeutic levels and bleeding in hospitalized patients with morbid obesity.
Prospective, masked observational cohort study of 41 hospitalized patients with morbid obesity (body mass index ≥40 kg/m² or actual body weight ≥140 kg) receiving treatment-dose enoxaparin (>60 mg/day).
Blood samples were collected to measure steady-state peak antifactor Xa levels and evaluate clinical bleeding outcomes.
The mean enoxaparin doses resulting in therapeutic and supratherapeutic steady-state anti-Xa levels were 0.83 mg/kg and 0.98 mg/kg, respectively (difference -0.11 mg/kg; 95% CI -0.20 to -0.01, P = .02).
Patients receiving doses <0.95 mg/kg had significantly lower odds of supratherapeutic anti-Xa levels compared to those receiving ≥0.95 mg/kg (odds ratio 0.21, 95% CI 0.05–0.84, P = .02), with similar rates of subtherapeutic levels.
Bleeding rates were not significantly different between patients receiving doses <0.95 mg/kg (17.9%) and ≥0.95 mg/kg (22.2%, P = .71).

Structured PICO

Does enoxaparin dose <0.95 mg/kg prevent supratherapeutic anti-Xa levels in hospitalized patients with morbid obesity compared to doses ≥0.95 mg/kg?

Population

41 hospitalized patients with morbid obesity (BMI ≥40 kg/m² or actual body weight ≥140 kg) prescribed treatment doses of enoxaparin >60 mg per day

Intervention

Enoxaparin dose <0.95 mg/kg

Comparator

Enoxaparin dose ≥0.95 mg/kg

Outcome

Therapeutic and supratherapeutic anti-Xa levels at steady statesurrogate

In hospitalized patients with morbid obesity, enoxaparin doses lower than the standard 1 mg/kg are more likely to achieve therapeutic anti-Xa levels without increasing subtherapeutic levels or bleeding.

Cite This Study

Thompson‐Moore et al. (2015) studied this question.

synapsesocial.com/papers/6a728f7035aa2c282ce3514f https://doi.org/10.1177/1076029614568713

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Implication

Lower enoxaparin doses associated with fewer supratherapeutic anti-Xa levels in morbid obesity; hypothesis-generating and should not change practice without RCTs.

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

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider