Comparison of two escalated enoxaparin dosing regimens for venous thromboembolism prophylaxis in obese hospitalized patients

Gibson, Caitlin M.; Hall, Courtney D.; Davis, Sondra; Schillig, Jessica

doi:10.1007/s11239-020-02360-9

Cited by 3 publications

(7 citation statements)

References 25 publications

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“…A total of 3153 participants with a standard dosage and 3113 with a higher dosage were included. These studies included 4 randomized controlled trials ( 19 , 20 , 23 , 25 ), 5 prospective cohort studies ( 21 , 22 , 24 , 26 , 27 ), and 2 retrospective cohort studies ( 28 , 29 ). Patients following bariatric surgery were the main target population for clinical VTE prevention ( 19 – 21 , 24 , 25 , 27 , 29 ).…”

Section: Resultsmentioning

confidence: 99%

“…As in normal-weight patients, most studies used subcutaneous 40 mg daily of enoxaparin as the standard dosage and 60 mg daily or 30 mg twice daily as the higher dosage ( 23 – 25 , 27 – 29 ). Few studies used a weight-based dosage (0.5 mg/kg 2 ) as a prophylactic option ( 26 ). It is worth noting that the standard dosage of the prophylaxis group at a few institutions was higher (40 mg twice daily) ( 27 ).…”

Section: Resultsmentioning

confidence: 99%

“…Dosage selection for the remainder of the studies was performed using site-specific criteria according to different types of LMWH drugs and different medical centers. Five studies recommended a higher dosage as a prophylactic strategy in patients with obesity ( 21 , 23 , 25 , 27 , 28 ), 3 studies maintained the traditional strategy ( 19 , 20 , 22 ), and an additional 3 studies considered the current findings controversial because the studies were small scale and the evidence was insufficient ( 24 , 26 , 29 ).…”

Section: Resultsmentioning

confidence: 99%

“…A standard prophylactic dosage of LMWH in most institutions is 40 mg QD, and higher dosages of LMWH are total dosages of 60-80 mg daily ( 19 , 20 , 22 – 26 , 28 , 29 ). We included two additional studies using 30 mg BID and 40 mg BID as standard dosages and 40 mg BID and 60 mg BID as higher dosages.…”

Section: Discussionmentioning

confidence: 99%

“…Gibson et al. compared the difference between a weight-based dosage (0.5 mg/kg) and a fixed dosage (40 mg twice daily) ( 26 ). There was no significant difference in anti-Xa levels between the two regimens.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Strategies involving low-molecular-weight heparin for the treatment and prevention of venous thromboembolism in patients with obesity: A systematic review and meta-analysis

Liu

Qiao

et al. 2023

Front. Endocrinol.

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IntroductionRecent studies have indicated that the dosage of LMWH in patients with specific weights may be controversial. Therefore, we conducted a meta-analysis to explore an appropriate dosage of LMWH for the prevention and treatment of venous thromboembolism (VTE) in patients with obesity.Materials and methodsWe searched the PubMed, EMBASE, and Cochrane Library databases up to July 23, 2022. Study selection, bias analysis, and information extraction were performed by three independent reviewers. The occurrence or recurrence of VTE and bleeding events were the primary outcomes we assessed.ResultsEleven studies (a total of 6266 patients) were included in the prevention group, and 6 studies (a total of 3225 patients) were included in the treatment group. For VTE prophylaxis, compared with the standard-dosage group, the high-dosage group had a lower incidence of VTE (OR: 0.47, 95% CI: 0.27-0.82, P=0.007) and a similar incidence of bleeding events (OR: 0.86, 95% CI: 0.69-1.08, P=0.020). For VTE therapy, compared to the standard-dosage group, the reduced-dosage group had a similar incidence of VTE recurrence (OR: 0.86, 95% CI: 0.11-6.84, P=0.89) but a lower incidence of bleeding events (OR: 0.30, 95% CI: 0.10-0.89, P=0.03).ConclusionIn patients with obesity, increasing the dosage of LMWH is a more appropriate option for the prevention of VTE. Due to the limited evidence, reducing the therapeutic dosage of LMWH requires careful consideration. Larger-scale, well-designed randomized controlled trials are necessary.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?, identifier ID=CRD42022298128.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Strategies involving low-molecular-weight heparin for the treatment and prevention of venous thromboembolism in patients with obesity: A systematic review and meta-analysis

Liu

Qiao

et al. 2023

Front. Endocrinol.

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Response to Comment to the Article “Does the Use of Prognostic Scales and Clinical Guidelines Always Guarantee the Survival of Patients with Massive Pulmonary Embolism”

Лебедев¹,

Gilyarov²,

Efremova³

et al. 2023

Flebol.

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Venous Thromboembolism Prophylaxis in Major Orthopedic Surgeries and Factor XIa Inhibitors

Jones

Al‐Horani

2023

Medical Sciences

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Venous thromboembolism (VTE), comprising pulmonary embolism (PE) and deep vein thrombosis (DVT), poses a significant risk during and after hospitalization, particularly for surgical patients. Among various patient groups, those undergoing major orthopedic surgeries are considered to have a higher susceptibility to PE and DVT. Major lower-extremity orthopedic procedures carry a higher risk of symptomatic VTE compared to most other surgeries, with an estimated incidence of ~4%. The greatest risk period occurs within the first 7–14 days following surgery. Major bleeding is also more prevalent in these surgeries compared to others, with rates estimated between 2% and 4%. For patients undergoing major lower-extremity orthopedic surgery who have a low bleeding risk, it is recommended to use pharmacological thromboprophylaxis with or without mechanical devices. The choice of the initial agent depends on the specific surgery and patient comorbidities. First-line options include low-molecular-weight heparins (LMWHs), direct oral anticoagulants, and aspirin. Second-line options consist of unfractionated heparin (UFH), fondaparinux, and warfarin. For most patients undergoing knee or hip arthroplasty, the initial agents recommended for the early perioperative period are LMWHs (enoxaparin or dalteparin) or direct oral anticoagulants (rivaroxaban or apixaban). In the case of hip fracture surgery, LMWH is recommended as the preferred agent for the entire duration of prophylaxis. However, emerging factor XI(a) inhibitors, as revealed by a recent meta-analysis, have shown a substantial decrease in the occurrence of VTE and bleeding events among patients undergoing major orthopedic surgery. This discovery poses a challenge to the existing paradigm of anticoagulant therapy in this specific patient population and indicates that factor XI(a) inhibitors hold great promise as a potential strategy to be taken into serious consideration.

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Comparison of two escalated enoxaparin dosing regimens for venous thromboembolism prophylaxis in obese hospitalized patients

Cited by 3 publications

References 25 publications

Strategies involving low-molecular-weight heparin for the treatment and prevention of venous thromboembolism in patients with obesity: A systematic review and meta-analysis

Strategies involving low-molecular-weight heparin for the treatment and prevention of venous thromboembolism in patients with obesity: A systematic review and meta-analysis

Response to Comment to the Article “Does the Use of Prognostic Scales and Clinical Guidelines Always Guarantee the Survival of Patients with Massive Pulmonary Embolism”

Venous Thromboembolism Prophylaxis in Major Orthopedic Surgeries and Factor XIa Inhibitors

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