Enoxaparin Dosing at Extremes of Weight: Literature Review and Dosing Recommendations

Sebaaly, Jamie; Covert, Kelly L.

doi:10.1177/1060028018768449

Cited by 59 publications

(53 citation statements)

References 39 publications

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“…The most current ASH guidelines maintain that optimal dosing of parenteral anticoagulation in underweight patients is an area for further research . Despite this, the latest review article recommends enoxaparin 30 mg daily in those with low body weight . In our study, some patients received < 30 mg daily, but for practicality, a 30‐mg dose of enoxaparin seems most appropriate given the availability of this prefilled syringe size.…”

Section: Resultsmentioning

confidence: 82%

“…10 Despite this, the latest review article recommends enoxaparin 30 mg daily in those with low body weight. 16 In our study, some patients received < 30 mg daily, but for practicality, a 30-mg dose of enoxaparin seems most appropriate given the availability of this prefilled syringe size. With the lack of randomized controlled trials, larger prospective analyses are needed to further investigate the correlation between aFXa levels and clinical outcomes of bleeding and thrombosis as well as the most appropriate enoxaparin VTE prophylaxis dose in this patient population.…”

Section: Resultsmentioning

confidence: 83%

“…Some low‐weight patients at our institution were prescribed enoxaparin 30 mg subcutaneously daily for VTE prophylaxis based on the discretion of each clinician. A recent publication and literature review supported this dose in patients with body mass index (BMI) < 18 kg/m 2 or total body weight < 55 kg . The objective of this study was to evaluate the proportion of peak aFXa levels at goal in low‐weight patients receiving enoxaparin for VTE prophylaxis.…”

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confidence: 99%

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Enoxaparin Thromboprophylaxis Dosing and Anti–Factor Xa Levels in Low‐Weight Patients

et al. 2019

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Introduction Enoxaparin is a widely used anticoagulant to prevent venous thromboembolism (VTE). A fixed dose is recommended for VTE prophylaxis. However, fixed prophylactic doses of enoxaparin in low‐weight patients may be close to the weight‐based dosing recommended for VTE treatment. Objective To evaluate peak anti–factor Xa (aFXa) levels in low‐weight patients receiving enoxaparin for VTE prophylaxis. Methods Retrospective cohort of adult patients weighing < 55 kg who were hospitalized at Loma Linda University Medical Center between January 2008 and February 2017. All patients received enoxaparin for VTE prophylaxis with a peak aFXa level drawn. The primary endpoint was the proportion of patients achieving peak aFXa levels within the goal range of 0.2–0.5 unit/ml. Results Of 35 patients receiving enoxaparin for VTE prophylaxis with an appropriately timed peak aFXa level, 74% achieved goal peak aFXa levels and the median daily dose of enoxaparin was 30 mg. The mean weight was approximately 44 kg. No significant correlations between aFXa level and body mass index or body weight were found. Conclusion A lower dose of enoxaparin may be reasonable in low‐weight patients for VTE prophylaxis. There appears to be no safety concerns with reduced enoxaparin dosing in low‐weight patients. More robust data are needed to confirm these findings.

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Section: Resultsmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 83%

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confidence: 99%

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Enoxaparin Thromboprophylaxis Dosing and Anti–Factor Xa Levels in Low‐Weight Patients

et al. 2019

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“…These patients should be given a weight‐adjusted appropriate prophylactic dose at admission, with an increase to intermediate intensity or full therapeutic dose based on clinical parameters (Figure 1). 34,35 Treatment doses also require adjustment for weight 36,37 …”

Section: Special Patient Population: Obesitymentioning

confidence: 99%

ISTH DIC subcommittee communication on anticoagulation in COVID‐19

Thachil

Juffermans

Ranucci

et al. 2020

Journal of Thrombosis and Haemostasis

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Hypercoagulability is an increasingly recognized complication of SARS‐CoV‐2 infection. As such, anticoagulation has become part and parcel of comprehensive COVID‐19 management. However, several uncertainties exist in this area, including the appropriate type and dose of heparin. In addition, special patient populations, including those with high body mass index and renal impairment, require special consideration. Although the current evidence is still insufficient, we provide a pragmatic approach to anticoagulation in COVID‐19, but stress the need for further trials in this area.

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“…For patients who are not in intensive care unit (ICU), we recommend a weight-adjusted LMWH prophylactic dose with a minimum of 50 anti-Xa IU/kg once-daily, irrespective of renal function. Several studies indeed suggest that a standard fixed VTE prophylaxis dose may not be appropriate in patients at extremes of weight [32].…”

Section: Anticoagulation Regimen For Thromboprophylaxis In Hospitalismentioning

confidence: 99%

Belgian clinical guidance on anticoagulation management in hospitalised and ambulatory patients with COVID-19

Vanassche

Orlando

Vandenbosch³

et al. 2020

Acta Clinica Belgica

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Objectives: COVID-19 predisposes patients to thrombotic disease. The aim of this guidance document is to provide Belgian health-care workers with recommendations on anticoagulation management in COVID-19 positive patients. Methods: These recommendations were based on current knowledge and a limited level of evidence. Results: We formulated recommendations for the prophylaxis and treatment of COVID-related venous thromboembolism in ambulatory and hospitalised patients, as well as recommendations for the use of antithrombotic drugs in patients with prior indication for anticoagulation who develop COVID-19. Conclusions: These recommendations represent an easy-to-use practical guidance that can be implemented in every Belgian hospital and be used by primary care physicians and gynaecologists. Of note, they are likely to evolve with increased knowledge of the disease and availability of data from ongoing clinical trials.

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Enoxaparin Dosing at Extremes of Weight: Literature Review and Dosing Recommendations

Cited by 59 publications

References 39 publications

Enoxaparin Thromboprophylaxis Dosing and Anti–Factor Xa Levels in Low‐Weight Patients

Enoxaparin Thromboprophylaxis Dosing and Anti–Factor Xa Levels in Low‐Weight Patients

ISTH DIC subcommittee communication on anticoagulation in COVID‐19

Belgian clinical guidance on anticoagulation management in hospitalised and ambulatory patients with COVID-19

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