Implementation of an Enoxaparin Protocol for Venous Thromboembolism Prophylaxis in Obese Surgical Intensive Care Unit Patients

Abstract

Weight-based dosing with enoxaparin in morbidly obese SICU patients was effective in achieving anti-factor Xa levels within the appropriate prophylactic range. This regimen reduced the rate of VTE below expected levels and no additional adverse effects were reported.

Perioperative rates of deep vein thrombosis and pulmonary embolism in normal weight vs obese and morbidly obese surgical patients in the era post venous thromboembolism prophylaxis guidelines

“…18 The 8th edition of American College of Chest Physicians (ACCP) chest guidelines suggests weight-based prophylaxis, and another study showed that there were no increased adverse events when VTE prophylaxis was increased by weight. 24 Limitations of our study include the inherent problems associated with using an administrative database, such as the possibility of coding errors and ambiguous coding. There are some inherent limitations of the NSQIP database, such as lack of information regarding compliance with DVT prophylaxis, prophylaxis regimen, or absence of such because of concerns for bleeding.…”

Deep Vein Thrombosis Prophylaxis Evaluation in Intensive Care Unit

“…Cancer, trauma, history of VTE and major orthopedic procedures are considered as high risk states (6) that nearly all ICU patients have at least one risk factor for DVT or PE, and additional risk factors are supposed to have a cumulative effect according to American society of health-system pharmacists. One of the most common and serious complications in ICU patients was venous thromboembolism and PE causes about 10% of hospital deaths (7).…”

Chemical prophylaxis to prevent venous thromboembolism in morbid obesity: literature review and dosing recommendations

“…This trial did report rates of thrombosis and found a correlation with weight, but this data was confounded by the fact that 16 of the 18 patients who developed a DVT did so before, or on the day of, enoxaparin initiation. A second retrospective trial using the same dosing regimen in 23 obese surgical ICU patients (mean BMI 46.4 mg/m 2 ) also found a very high rate of patients achieving an anti-Xa level in goal range (91 % between 0.2-0.5 IU/mL), with a mean anti-Xa level of 0.34 IU/mL [28]. One case of minor bleeding and one DVT which was potentially present prior to initiation of VTE prophylactic enoxaparin were reported in this study [28].…”