High-Dose Venous Thromboembolism Prophylaxis for Obese Patients

Recent reports confirm that the standard dose of enoxaparin in obese patients is often subtherapeutic, leading to a higher incidence of venous thromboembolism. All patients receiving subcutaneous enoxaparin 30 mg twice a day (b.i.d.) for venous thromboembolism prophylaxis were prospectively enrolled in this study. Trough antiXa levels were obtained and any level less than 0.1 IU/mL was considered subtherapeutic and the final dosage requirement was recorded. Body mass index (BMI), abdominal wall thickness, and fluid balance were collected. Thirty-four patients were prospectively enrolled in the study, 14 (50%) of which had a BMI >30. Sixty-five per cent of obese patients were initially nontherapeutic, compared with 53 per cent of the nonobese ( P = 0.73). However, elevated BMI ( P < 0.05) and abdominal wall thickness ( P < 0.05) correlated to an increased final dose required to attain an anti Xa ≥0.1 when not initially therapeutic, whereas fluid balance demonstrated no correlation ( P = 0.232). Subcutaneous enoxaparin dosing of 30 mg b.i.d. is not sufficient for the majority adult trauma patients in the intensive care unit, regardless of BMI. When enoxaparin 30 mg b.i.d. is initially subtherapeutic, obese patients may require a larger dose necessary to achieve necessary anticoagulation.

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Efficacy of Venous Thromboembolism Prophylaxis in Morbidly Obese Patients Undergoing Gastric Bypass Surgery

Obesity Surgery ◽

10.1381/096089205774512690 ◽

2005 ◽

Vol 15 (9) ◽

pp. 1316-1320 ◽

Cited By ~ 40

Author(s):

Samantha Ann Cotter ◽

Wendy Cantrell ◽

Barry Fisher ◽

Rinah Shopnick

Keyword(s):

Gastric Bypass ◽

Venous Thromboembolism ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Morbidly Obese ◽

Obese Patients ◽

Thromboembolism Prophylaxis ◽

Venous Thromboembolism Prophylaxis

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Comparison of the effectiveness of venous thromboembolism prophylaxis with enoxaparin between obese and non-obese patients

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155218760159 ◽

2018 ◽

Vol 25 (4) ◽

pp. 813-817 ◽

Cited By ~ 3

Author(s):

Abdelmajid H Alnatsheh ◽

Robert D Beckett ◽

Stacy Waterman

Keyword(s):

Body Mass Index ◽

Venous Thromboembolism ◽

Body Mass ◽

Hospitalized Patients ◽

Obese Group ◽

Obese Patients ◽

Thromboembolism Prophylaxis ◽

Venous Thromboembolism Prophylaxis ◽

Significant Difference ◽

Group 2

Objective The purpose of this study is to compare the incidence of venous thromboembolism between obese and non-obese hospitalized patients who received United States Food and Drug Administration-approved prophylactic enoxaparin doses and to describe enoxaparin dosing strategies used in obese patients. Methods This was a retrospective cohort study including patients who were admitted to Parkview Regional Medical Center, Parkview Hospital, or Parkview Orthopedic Hospital between September 2011 and August 2012 and received at least one dose of enoxaparin 30 mg twice daily or enoxaparin 40 mg once daily for venous thromboembolism prophylaxis. Patients classified based on their body mass index into three groups, Group 1 (non-obese: body mass index < 25 kg/m2), Group 2 (overweight: body mass index ≥ 25 kg/m2 but < 30 kg/m2), and Group 3 (obese: body mass index ≥ 30 kg/m2). The primary endpoint was venous thromboembolism occurrence within 90 days, considering day 1 of hospitalization as day 1. Results Of the 428 patients included, 8 cases of venous thromboembolism (1.9%) were identified; 3 in the non-obese group, 2 in the overweight group, and 3 in the obese group, no statistically significant differences were found between the three groups, p = 0.81. When venous thromboembolism incidence was adjusted for age and sex, no statistically significant differences were found between overweight (OR = 0.685; 95% CI 0.115–4.095), obese (OR = 0.797; 95% CI 0.353–1.796), and combined overweight and obese (OR = 0.656; 95% CI 0.154–2.799) groups compared to patients with normal body weight. Conclusion This study did not find a statistically significant difference in venous thromboembolism incidence between obese, overweight, and non-obese hospitalized patients receiving approved enoxaparin prophylaxis doses.

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