Weight‐Based Dosing of Enoxaparin in Obese Patients with Non‐ST‐Segment Elevation Acute Coronary Syndromes: Results from the CRUSADE Initiative
Why the study?
Does the recommended weight-based dose of enoxaparin increase major bleeding compared to a reduced dose in obese patients with non-ST-segment elevation acute coronary syndromes?
Population
19,061 patients who received enoxaparin for the initial treatment of non-ST-segment elevation acute coronary…
Comparison
Enoxaparin at recommended dose (0.95-1.05 mg/kg) vs Enoxaparin at reduced dose (< 0.95 mg/kg)
Design
Cohort
Authors
Discussion
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Member takes
Implication
May warrant caution with standard enoxaparin dosing in very obese NSTE-ACS; leaves open optimal strategy pending randomized confirmation.
Structured PICO
Does the recommended weight-based dose of enoxaparin increase major bleeding compared to a reduced dose in obese patients with non-ST-segment elevation acute coronary syndromes?
P
Population
19,061 patients who received enoxaparin for the initial treatment of non-ST-segment elevation acute coronary syndromes
I
Intervention
Enoxaparin at recommended dose (0.95-1.05 mg/kg)
C
Comparator
Enoxaparin at reduced dose (< 0.95 mg/kg)
O
Outcome
Major bleeding unrelated to coronary artery bypass graft (CABG) surgerysafety
In very obese patients (>150 kg) with NSTE-ACS, standard weight-based enoxaparin dosing (1 mg/kg) may increase bleeding risk compared to reduced dosing, suggesting a need for dose adjustments.
Limitations
- Limited data in very obese patients
Cite This Study
Spinler et al. (2009) studied this question.