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

2018 ◽  
Vol 25 (4) ◽  
pp. 813-817 ◽  
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.

scholarly journals Evaluation of the impact of body mass index on warfarin requirements in hospitalized patients

2018 ◽  
Vol 12 (8) ◽  
pp. 207-216 ◽  
Author(s):  
Katie B. Tellor ◽  
Steffany N. Nguyen ◽  
Amanda C. Bultas ◽  
Anastasia L. Armbruster ◽  
Nicholas A. Greenwald ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
International Normalized Ratio ◽  
Hospitalized Patients ◽  
Morbidly Obese ◽  
Weekly Dose ◽  
Obese Patients ◽  
Significant Difference ◽  
Underweight Patients ◽  
The Impact

Background: Despite well established empiric dose adjustments for drug and disease-state interactions, the impact of body mass index (BM) on warfarin remains unclear. The objective of this study is to evaluate warfarin requirements in hospitalized patients, stratified by BMI. Methods: This retrospective review included two cohorts of patients: cohort A (patients admitted with a therapeutic international normalized ratio (INR)) and cohort B (newly initiated on warfarin during hospitalization). Exclusion criteria included: age under 18 years, pregnancy, INR (goal 2.5–3.5), and warfarin thromboprophylaxis post orthopedic surgery. The primary outcome was mean total weekly dose (TWD) of warfarin based on weight classification: underweight (BMI <18 kg/m2), normal/overweight (BMI 18–29.9 kg/m2), obese (BMI 30–39.9 kg/m2), and morbidly obese (BMI ⩾ 40 kg/m2). Data were extracted from two community hospitals in reverse chronologic order during July 2015–June 2013 until both study institutions evaluated 100 patients per cohort in each BMI classification or until all patients had been evaluated within the prespecified timeframe. Results: A total of 585 patients were included in cohort A (26 underweight, 200 normal/overweight, 200 obese, 159 morbidly obese). There was a statistically significant difference in TWD as determined by one-way analysis of variance ( p < 0.05). A Tukey post hoc test revealed a statistically significantly higher TWD in morbidly obese (41.5 mg) compared with underweight (25.6 mg, p < 0.05), normal/overweight (28.8 mg, p < 0.05) and obese patients (32.4 mg, p < 0.05). In cohort B, 379 patients were evaluated (9 underweight, 166 normal/overweight, 152 obese, 52 morbidly obese). Overall, 191 patients had a therapeutic INR on discharge (88.9% underweight, 52.4% normal/overweight, 44.1% obese, 55.8% morbidly obese, p = 0.035). Of those, there was a statistically significant difference in TWD ( p = 0.021) with a higher TWD in the morbidly obese (41 mg) compared with underweight patients (24.4 mg, p = 0.017). Conclusions: Based on the results of this study, morbidly obese patients may require higher TWD to obtain and maintain a therapeutic INR.

scholarly journals Abdominal fat ratio – a novel parameter for predicting conversion in laparoscopic colorectal surgery

2017 ◽  
Vol 99 (1) ◽  
pp. 46-50 ◽  
Author(s):  
SI Scott ◽  
S Farid ◽  
C Mann ◽  
R Jones ◽  
P Kang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Body Mass Index ◽  
Body Mass ◽  
Conversion Rate ◽  
Abdominal Cavity ◽  
Abdominal Fat ◽  
Obese Group ◽  
Obese Patients ◽  
Cancer Resection ◽  
Colorectal Cancer Resection

INTRODUCTION Laparoscopic surgery has become the standard for colorectal cancer resection in the UK but it can be technically challenging in patients who are obese. Patients whose body fat is mainly inside the abdominal cavity are more challenging than those whose fat is mainly outside the abdominal cavity. Abdominal fat ratio (AFR) is a simple parameter proposed by the authors to aid identification of this subgroup. MATERIALS AND METHODS All 195 patients who underwent elective, laparoscopic colorectal cancer resections from March 2010 to November 2013 were included in the study. For patients who were obese (body mass index greater than 30), preoperative staging computed tomography was used to determine AFR. This was assessed by two different, blinded observers and compared with conversion rate. RESULTS Of the 195 patients, 58 (29.7%) fell into the obese group and 137 (70.3%) into the non-obese group. The median AFR of the obese group that were converted to open surgery was significantly higher at 5.9 compared with those completed laparoscopically (3.3, P = 0.0001, Mann-Whitney). There was no significant difference in conversion rate when looking at body mass index, tumour site or size. DISCUSSION Previous studies have found body mass index, age, gender, previous abdominal surgery, site and locally advanced tumours to be associated with an increased risk of conversion. This study adds AFR to the list of risk factors. CONCLUSION AFR is a simple, reproducible parameter which can help to predict conversion risk in obese patients undergoing colorectal cancer resection.

scholarly journals Results of a venous thromboembolism prophylaxis program for hospitalized patients

2016 ◽  
Vol Volume 12 ◽  
pp. 491-496 ◽  
Author(s):  
Luiz Cardoso ◽  
Daniella Krokoscz ◽  
Edison Paiva ◽  
Ilka Furtado ◽  
Jorge Mattar Jr ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Hospitalized Patients ◽  
Thromboembolism Prophylaxis ◽  
Venous Thromboembolism Prophylaxis

scholarly journals TRAUMATIC DISEASE PECULIARITIES COURSE, ITS DIAGNOSTICS AND TREATMENT AT POLYTRAUMA IN SUFFER OBESE PATIENTS

2019 ◽  
Vol 43 (4) ◽  
pp. 47-53
Author(s):  
S.D. Khimich ◽  
O. M. Chemerys
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Body Mass ◽  
Overweight And Obesity ◽  
The Body ◽  
Obese Patients ◽  
Prognostic Features ◽  
Normal Body ◽  
Significant Difference ◽  
Normal Body Weight

Abstract Introduction. It’s known that the issue of polytrauma is one of the most urgent problems of surgery, and among injured patients a special approach is required for patients with overweight and obesity of varying degrees. Purpose of the study. To study prognostic features of traumatic disease course and to improve the results of diagnostics and surgical treatment of patients with polytrauma suffer obesity. Materials and methods. Clinical material was made up of 106 patients with combined body trauma, which were divided into three groups according to body mass index. Results. The results of the research showed a significant difference in the course of traumatic disease in patients with normal body weight and obesity. In particular, in the process of diagnostics of blunt chest and abdominal trauma the frequency of application of interventional methods of diagnostics was directly proportional to the increase of body mass index. The course of traumatic disease in the obese patients had a number of characteristic features that formed the basis for the development of diagnostics and differential program of treatment. Conclusions. The results of the research showed that the course of traumatic disease in combined injury obese patients is directly proportional to the body mass index and has certain features that differentiate them from patients with normal body weight. Keywords: polytrauma, obesity, traumatic disease, diagnostics, treatment.

scholarly journals A comparative study of novel biomarkers on preeclampsia in relation to body mass index

2020 ◽  
Vol 11 (1) ◽  
pp. 913-920
Author(s):  
Sabir Ali Shaikh ◽  
Rajagopalan Vijayaraghavan ◽  
Das Subir Kumar ◽  
Pal Manidip
Keyword(s):  
Nitric Oxide ◽  
Body Mass Index ◽  
Body Mass ◽  
Overweight And Obesity ◽  
Soluble Endoglin ◽  
Significant Difference ◽  
Novel Biomarkers ◽  
Group 2 ◽  
Oxide Synthase ◽  
Endothelial Nitric Oxide

Objective of the study was to compare serum level of nitric oxide (NO), endothelial nitric oxide synthase (eNOS), asymmetric dimethylarginine (ADMA), arginine, placental growth factor (PIGF), soluble Fms like tyrosine kinase-1 (sFlt-1), soluble endoglin (sEng), malondialdehyde (MDA), glutathione peroxidase (GPx), superoxide dismutase (SOD) and catalase, in normotensive and preeclamptic pregnancies in relation to body mass index (BMI). The study was done on 100 healthy normotensive and 100 preeclamptic pregnant women. Based on BMI, they were categorized into three groups. Group 1 (<25 kg/m2), group 2 (25 – 30 kg/m2) and group 3 (>30 kg/m2).  ADMA, eNOS, arginine, PlGF, sFlt-1, sEng were estimated by ELISA method, and MDA, NO, GPx, SOD, and catalase by spectrophotometric method. Statistically, a significant difference was not observed within normotensive and preeclampsia in relation to BMI. But when respective normotensive was compared with preeclampsia, there was a high increase of ADMA, sFlt-1, sEng, and MDA. A significant decrease was observed in arginine, eNOS, NO, GPx, SOD, and catalase in preeclampsia. This study shows that though preeclampsia is associated with overweight and obesity, but during pregnancy, higher BMI has no additional deleterious effect in preeclampsia.

scholarly journals Retrospective Study of Venous Thromboembolism Prophylaxis Dosing of Heparin in Adult Patients receiving Continuous Renal Replacement Therapy

2021 ◽  
Vol 6 (2) ◽  
Keyword(s):  
Venous Thromboembolism ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Safety Outcome ◽  
Venous Thromboembolism Prophylaxis ◽  
Efficacy Outcome ◽  
Significant Difference ◽  
Dosing Intervals

Background: Appropriate chemical and/or mechanical venous thromboembolism prophylaxis is a high priority for clinicians. Unfortunately, there is little evidence-based guidance for clinical decision making for patients requiring both renal replacement therapy and VTE prophylaxis. The package insert for unfractionated heparin recommends 5000 units subcutaneously every 8 to 12 hours for VTE prophylaxis. Objective: The purpose of this study was to assess the two recommended dosing intervals and determine if there is a difference in terms of incidence of clotting or bleeding events. Methods: 159 patients were admitted to the UNC Health Care system between March 2014 and November 2019 and retrospectively screened for incidence of both the primary composite efficacy outcome (symptomatic or asymptomatic vascular event (VTE [DVT and PE]), ischemic event (stroke, TIA, or myocardial infarction), or death related to coagulopathy), the individual components of the composite outcome and the primary safety outcome. The results of the outcomes were then compared and analyzed using Fischer’s Exact test. Results: The two tailed p-values of the primary composite efficacy outcome (0.3517), the primary safety outcome (0.1571) and each of the composite outcomes (0.1556, 1.0000, 0.2297, respectively) showed no statistically significant difference. Conclusion: Results of this study show that there is no statistical difference between the dosing intervals of prophylactic UFH of every 8 to 12 hours, in terms of the incidence of VTE and major bleed events, for patients requiring CRRT. Suggesting that either interval is both efficacious and safe for the use of VTE prophylaxis.

Pattern of chemotherapy dosing in obese patients in a community hospital.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e13099-e13099
Author(s):  
Malar Thwin ◽  
Aye Min Soe ◽  
Nay Min Tun ◽  
Gina M. Villani
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Dose Adjustment ◽  
Drug Exposure ◽  
Obese Patients ◽  
Chi Square ◽  
Full Dose ◽  
Reduced Dose ◽  
Significant Difference ◽  
Chemotherapy Dose

e13099 Background: Obesity has increased to epidemic proportions, with 32.2% of US adults aged 20 years or older classified as obese (body mass index ≥ 30 mg/m2). In view of altered pharmacokinetics and possible excessive toxicity in obese patients, chemotherapy dose reductions are often employed in treating obese cancer patients. To our knowledge, there are no reports in the literature identifying patients who should have empiric dose adjustment because of obesity or the best method of dosing chemotherapy to standardize drug exposure in patients with varying degrees of obesity. As practice varies among institutions, we carried out a retrospective study to evaluate the chemotherapy dosing pattern in our obese patient population. Methods: Charts of patients who received chemotherapy at our institution during the year 2010 were reviewed. Data on age, height, weight, type and stage of cancer, date of chemotherapy, and type and dose of chemotherapy were retrieved from chart review. Only details of the first chemotherapy cycle at our institution were collected. Body surface area (BSA) was calculated by using the Mosteller formula. Independent samples t-test and Pearson chi-square statistics were used to investigate the difference between the means and proportions respectively. Results: Data from 191 patients were analyzed. Distributions (mean and range) of age, height, weight, body mass index (BMI) and BSA were 60 years (26 - 88), 65 inches (53 - 79), 166 pounds (90 - 340), 27.44 kg/m2 (14.52 - 56.57) and 1.85 m2 (1.36 - 2.66), respectively. Patients who had a full dose (n = 164) had a mean BMI of 27 kg/m2 (standard deviation (SD) 6.5) and a mean BSA of 1.82 m2 (SD 0.24) whereas those with a reduced dose had BMI (n = 27, mean 30.2, SD 7.1) and BSA (mean 1.97, SD 0.25). There is a significant difference between the means of the two groups (full dose and reduced dose) in terms of both BSA and BMI (p = 0.033 and p = 0.01, respectively). Significantly higher proportion of patients with BSA ≥ 2 received reduced dose compared to those with BSA < 2 (14 out of 48 (20.3%) versus 13 out of 143 (9%), p = 0.001). Conclusions: Patients with BSA ≥ 2 were more likely to get empiric chemotherapy dose adjustment at our institution. Further studies on chemotherapy dosing in obese patients are warranted.

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