What question did this study set out to answer?

Determine an optimal enoxaparin dosing strategy for overweight and obese patients using population pharmacokinetic-pharmacodynamic modeling.

July 1, 2003British Journal of Clinical PharmacologyOpen Access

Development of a dosing strategy for enoxaparin in obese patients

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Why the study?

What is the optimal dosing strategy for enoxaparin in overweight and obese patients to achieve appropriate anti-Xa concentrations and minimize bruising?

Population

96 patients admitted to the Royal Brisbane Hospital prescribed enoxaparin as part of their normal care, with…

Design

Cohort

Authors

BGBruce GreenFordham University SDStephen B. DuffullUppsala University

Discussion

Member takes

Implication

May support lean body weight-based enoxaparin dosing to minimize bruising in obese patients; hypothesis-generating and requires prospective validation.

Key Points

Determine an optimal enoxaparin dosing strategy for overweight and obese patients using population pharmacokinetic-pharmacodynamic modeling.
Prospective study of 96 hospitalized patients stratified equally across BMI categories (<24.9, 25–29.9, and >30 kg/m²).
Collected approximately three blood samples per patient to measure anti-Xa concentrations and recorded bruising occurrence.
Conducted population pharmacokinetic-pharmacodynamic modeling using NONMEM and performed dosing simulations with MATLAB.
A two-compartment linear model showed enoxaparin clearance was best described by lean body weight, whereas central distribution volume was best described by total body weight.
Logistic regression identified peak concentration (Cmax) and patient age as the primary predictors of bruising probability.
Simulations demonstrated that 100 IU/kg (1 mg/kg) based on lean body weight every 8 hours yields smoother concentration profiles and less bruising in patients >50 years weighing >90 kg or <50 years weighing >120 kg.

Structured PICO

What is the optimal dosing strategy for enoxaparin in overweight and obese patients to achieve appropriate anti-Xa concentrations and minimize bruising?

Population

96 patients admitted to the Royal Brisbane Hospital prescribed enoxaparin as part of their normal care, with one-third having BMI < 24.9 kg/m², one-third 25-29.9 kg/m², and one-third > 30 kg/m².

Intervention

Enoxaparin dosing (pharmacokinetic-pharmacodynamic modeling and simulation)

Outcome

Anti-Xa concentrations and occurrence of bruisingsurrogate

Enoxaparin dose adjustments based on lean body weight in obese patients may optimize concentration-time profiles and reduce bruising.

Limitations

Prospective validation of the dosing strategy is required

Cite This Study

Green et al. (2003) studied this question.

synapsesocial.com/papers/6a81b2c8806e324fba06ccc3 https://doi.org/10.1046/j.1365-2125.2003.01849.x

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Implication

May support lean body weight-based enoxaparin dosing to minimize bruising in obese patients; hypothesis-generating and requires prospective validation.

Development of a dosing strategy for enoxaparin in obese patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Development of a dosing strategy for enoxaparin in obese patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider