Assessing an enoxaparin dosing protocol in morbidly obese patients

Lalama, Jeffrey; Feeney, Megan; Vandiver, Jeremy W.; Beavers, K; Walter, Leah N.; McClintic, Jacqueline R.

doi:10.1007/s11239-014-1117-y

Cited by 36 publications

(40 citation statements)

References 13 publications

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“…Similar finding were reported in a prior study by Lalama JT et al, 12 where dose adjustments of enoxaparin in obese patients were likely to reduce the occurrence of bruising. Furthermore, the duration of enoxaparin SC injection was another predictor that affects the bruising area and was significantly higher (p=0.001) in patients of the B group than those of the A group (3.19 ± 3.01) vs.…”

Section: And Discussionsupporting

confidence: 90%

Untitled

2017

IJPSR

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Enoxaparin is useful in the treatment of unstable angina, but its use is associated with many hematological side effects principally bruising appearance. A prospective comparative study was designed to evaluate the effects of certain predictors on the occurrence of bruising side effect of enoxaparin during the administration of two different subcutaneous (SC) doses (prophylactic vs. therapeutic) of enoxaparin injection among patients with unstable angina. Patients were divided into two groups, 60 patients served as A group given a prophylactic dose 40mg q12h. The other 60 patients served as the B group given 1mg/kg q12h. Area of the bruising was measured by disposable measuring tape as mm 2 . A significant higher occurrence in the mean of bruising area was found in males (P=0.014), geriatrics (P=0.001), patients with body weight more than 76 kg (P=0.007), therapy of 5-day duration (P=0.01), hypertensive patients and those treated with captopril (P=0.001) while receiving the therapeutic dose (B group) than those receiving the prophylactic dose (A group). In conclusion, certain predictors significantly affect the occurrence of enoxaparin bruising and could be considered clinically during the evaluation of bruising side effect of enoxaparin injection.

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Section: And Discussionsupporting

confidence: 90%

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2017

IJPSR

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“…The study evaluated 31 patients, and of those, 24 patients (77%) achieved therapeutic anti-Xa during their hospitalization. 18 …”

Section: Discussionmentioning

confidence: 99%

Anti-factor Xa levels in obese patients receiving enoxaparin for treatment and prophylaxis indications

Tahaineh¹,

Edaily²,

Gharaibeh³

2018

CPAA

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ObjectivesTo evaluate the degree of anticoagulation achieved with different enoxaparin dosing regimens used in obese and morbidly obese patients in a hospital setting in Jordan.MethodsAll obese adult patients who were prescribed enoxaparin for various indications were invited to participate in the study. The anti-factor Xa (anti-Xa) level was checked once after 4–6 hours of the third or fourth dose of enoxaparin (at steady state). Patients were followed daily to evaluate drug efficacy and safety through their hospital course.ResultsEnoxaparin daily dose used for prophylaxis indications ranged from 0.3 to 0.85 mg/kg and from 0.31 to 2.25 mg/kg in case of certain treatment indications. Most participants who received enoxaparin for treatment indications (76.9%) were on capping dosing regimens, which was <1 mg/kg twice daily. On the other hand, most patients (88.5%) who received enoxaparin for prophylaxis indications were on a fixed 40 mg/d dose. Among the 52 patients who completed the study, 19 patients (36.5%) had therapeutic anti-Xa levels. The results showed no statistically significant associations between regimens that were used and achieving therapeutic anti-Xa level (p>0.05). No bleeding events or thrombocytopenia were noticed, and there was one case of recurrent thrombosis.ConclusionEnoxaparin dosing regimens that were used for obese patients varied based on prescribing physicians. Regardless of the regimen used, the majority of participants had nontherapeutic anti-Xa. Individualized dosing regimens based on anti-Xa levels are warranted for obese patients on enoxaparin.

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“…Based upon bariatric data available, enoxaparin 40 mg subcutaneously every 12 hours may be employed for standard VTE prophylaxis. 21 In the presence of renal insufficiency, LWMH can be renally dose-adjusted (for example, enoxaparin 30 mg subcutaneously daily) or subcutaneous UFH therapy can be used instead. Preference may be given to subcutaneous UFH when renal function is poor or labile.…”

Section: Agent Selection For Tiered Anticoagulation Therapymentioning

confidence: 99%

Practical considerations in prevention and treatment of venous thromboembolism in hospitalized patients with COVID-19

Smith

Krajewski

2020

American Journal of Health-System Pharmacy

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Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose There are increasing reports in the literature of high rates of coagulopathy and venous thromboembolism (VTE) among hospitalized patients with coronavirus disease 2019 (COVID-19). Understanding of these abnormalities is continually evolving, but these conditions may pose a risk to COVID-19 patients beyond the risk typically seen in critically ill patients. Summary There are currently no widely accepted evidence-based guidelines regarding specifics related to treatment and prevention of COVID-19–related coagulopathies. Areas of management requiring clinical equipoise include agent selection and dosing, continuation vs interruption of home oral anticoagulant therapy during hospital admission, and postdischarge VTE prophylaxis. Clinicians may wish to consider use of a stratified, 3-tiered approach of low-intensity anticoagulation, intermediate-intensity anticoagulation, and therapeutic-dose anticoagulation. Patients can be categorized by tier depending on their risk factors for VTE, acuity of illness, and laboratory values such as D-dimer level. Conclusion Practical guidance on anticoagulation considerations and dosing suggestions are provided to assist clinicians faced with challenging anticoagulation-related situations in caring for hospitalized COVID patients until formal evidence-based guidelines become available.

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Assessing an enoxaparin dosing protocol in morbidly obese patients

Cited by 36 publications

References 13 publications

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Anti-factor Xa levels in obese patients receiving enoxaparin for treatment and prophylaxis indications

Practical considerations in prevention and treatment of venous thromboembolism in hospitalized patients with COVID-19

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