Document Detail

Prospective comparison of three enoxaparin dosing regimens to achieve target anti-factor Xa levels in hospitalized, medically ill patients with extreme obesity.
MedLine Citation:
PMID:  22565589     Owner:  NLM     Status:  MEDLINE    
Enoxaparin is commonly used to prevent venous thromboembolism(VTE) [1,2] but has not been well-studied in patients with extreme obesity,a population at high risk for VTE. We prospectively compared three enoxaparin dosing regimens for the achievement of goal peak anti-Factor Xa levels in medically ill patients (n 5 31) with extreme obesity (body mass index (BMI) ‡ 40 kg/m2). Patients were assigned to receive fixed-dose (FD) enoxaparin 40 mg daily (QDay, n 5 11), weight based,lower-dose (LD) enoxaparin 0.4 mg/kg QDay (n 5 9), or weight based,higher-dose (HD) enoxaparin 0.5 mg/kg QDay (n 5 11). The average BMI and weight of the entire cohort was 62.1 kg/m2 (range40.5–82.4) and 176 kg (range 115–256 kg) and did not differ between groups. Peak anti-Factor Xa levels were significantly higher in the HD group compared to either LD or FD groups. Patients in the HD group achieved target anti-Factor Xa levels more frequently than the LD and FD groups (P < 0.05). Peak anti-Factor Xa levels did not correlate with age, weight, BMI, or creatinine clearance, demonstrating the predictability of weight-based enoxaparin dosing. There were no adverse events (e.g., bleeding, thrombosis, thrombocytopenia). To our knowledge this is the first prospective comparative study demonstrating that in extremely obese, medically ill patients enoxaparin 0.5 mg/kg QDay is superior to FD and LD enoxaparin for the achievement of target anti-Factor Xa levels.
Andrew Freeman; Tuesdy Horner; Robert C Pendleton; Matthew T Rondina
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Publication Detail:
Type:  Comparative Study; Controlled Clinical Trial; Journal Article; Research Support, N.I.H., Extramural     Date:  2012-05-06
Journal Detail:
Title:  American journal of hematology     Volume:  87     ISSN:  1096-8652     ISO Abbreviation:  Am. J. Hematol.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-14     Completed Date:  2012-08-27     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  7610369     Medline TA:  Am J Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  740-3     Citation Subset:  IM    
Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
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MeSH Terms
Anticoagulants / administration & dosage*,  adverse effects,  therapeutic use
Bed Rest / adverse effects*
Blood Coagulation Tests
Body Mass Index
Cohort Studies
Dose-Response Relationship, Drug
Enoxaparin / administration & dosage*,  adverse effects,  therapeutic use
Factor Xa / antagonists & inhibitors*
Middle Aged
Obesity, Morbid / blood*,  complications,  physiopathology,  therapy
Pilot Projects
Venous Thromboembolism / etiology,  prevention & control*
Grant Support
Reg. No./Substance:
0/Anticoagulants; 0/Enoxaparin; EC Xa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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