August 1, 2014Hospital PharmacyOpen Access

Appropriate Enoxaparin Dose for Venous Thromboembolism Prophylaxis in Patients with Extreme Obesity

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Why the study?

Does higher than standard dosing of enoxaparin improve anti-Xa levels and prevent VTE in patients with extreme obesity compared to standard dosing?

Population

Patients with extreme obesity requiring venous thromboembolism prophylaxis. 8 studies included, primarily in…

Comparison

Higher than standard doses of enoxaparin. vs Standard doses of enoxaparin.

Design

Systematic_review

Authors

MSMax ShelkrotWilmington VA Medical Center JMJonida MirakaTemple University MPMirza E. PerezBellvitge University Hospital

Discussion

Member takes

Implication

Supports higher enoxaparin dosing for VTE prophylaxis in extreme obesity; confirms improved anti-Xa attainment and reduced incidence without excess bleeding.

Structured PICO

Does higher than standard dosing of enoxaparin improve anti-Xa levels and prevent VTE in patients with extreme obesity compared to standard dosing?

Population

Patients with extreme obesity requiring venous thromboembolism (VTE) prophylaxis. 8 studies included, primarily in patients undergoing bariatric surgery, but also including surgical intensive care unit (SICU) and hospitalized medically ill patients. Mean body mass index ranged from 44.9 to 63.4 kg/m2.

Intervention

Higher than standard doses of enoxaparin (e.g., 40 mg subcutaneous every 12 hours, 60 mg subcutaneous every 12 hours, or weight-based dosing such as 0.5 mg/kg/day).

Comparator

Standard doses of enoxaparin (e.g., 30 mg subcutaneous every 12 hours or 40 mg subcutaneous once daily).

Outcome

Incidence of venous thromboembolism (VTE) and/or anti-Xa levels.

Higher than standard doses of enoxaparin, such as 40 mg subcutaneous every 12 hours, may be necessary to achieve adequate VTE prophylaxis in patients with extreme obesity.

Limitations

Small sample sizes
Nonrandomized designs
Single-center studies
Lack of control for confounders
Controversy about appropriate anti-Xa levels
Lack of data in patients with renal dysfunction

Cite This Study

Shelkrot et al. (2014) studied this question.

synapsesocial.com/papers/6a728f7035aa2c282ce35150 https://doi.org/10.1310/hpj4908-740

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Implication

Supports higher enoxaparin dosing for VTE prophylaxis in extreme obesity; confirms improved anti-Xa attainment and reduced incidence without excess bleeding.

Appropriate Enoxaparin Dose for Venous Thromboembolism Prophylaxis in Patients with Extreme Obesity

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Appropriate Enoxaparin Dose for Venous Thromboembolism Prophylaxis in Patients with Extreme Obesity

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider