Monitoring Enoxaparin with Antifactor Xa Levels in Obese Patients

Lee, Young R.; Vega, J.A.; Duong, Hanh-Nhi Q.; Ballew, Austin

doi:10.1002/phar.1658

Cited by 24 publications

(33 citation statements)

References 21 publications

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“…40 kg/m 2 ) and concluded that the standard dose of 1 mg/kg was associated with a considerable risk of reaching supratherapeutic anti-Xa levels. 48,49 Also, Van Oosterom et al concluded that a dose of 0.75 to 0.85 mg/kg was most optimal in patients weighing > 100 kg based on anti-Xa levels. 50 On the contrary, Maclachlan et al found no difference in the proportion of patients reaching supratherapeutic anti-Xa levels with the recommended dose of 1 mg/kg twice daily in a comparison of patients weighing > 100 kg and patients weighing < 100 kg.…”

Section: Low-molecular-weight Heparin Used For Treatmentmentioning

confidence: 99%

Dosage of Anticoagulants in Obesity: Recommendations Based on a Systematic Review

Abildgaard

Madsen

Hvas

2020

Semin Thromb Hemost

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Anticoagulants are frequently used as thromboprophylaxis and in patients with atrial fibrillation (AF) or venous thromboembolism (VTE). While obesity rates are reaching epidemic proportions worldwide, the optimal dosage for obese patients has not been established for most anticoagulants, including low-molecular-weight heparin (LMWH), non–vitamin K antagonist oral anticoagulants (NOAC), and pentasaccharides (fondaparinux). The aim of the present systematic review was to summarize the current knowledge and provide recommendations on dosage of LMWH, NOAC, and fondaparinux in obese patients (body mass index [BMI] ≥ 30 kg/m2 or body weight ≥ 100 kg). Based on a systematic search in PubMed and Embase, a total of 72 studies were identified. For thromboprophylaxis with LMWH in bariatric surgery (n = 20 studies), enoxaparin 40 mg twice daily, dalteparin 5,000 IE twice daily, or tinzaparin 75 IU/kg once daily should be considered for patients with BMI ≥ 40 kg/m2. For thromboprophylaxis with LMWH in nonbariatric surgery and in medical inpatients (n = 8 studies), enoxaparin 0.5 mg/kg once or twice daily or tinzaparin 75 IU/kg once daily may be considered in obese patients. For treatment with LMWH (n = 18 studies), a reduced weight-based dose of enoxaparin 0.8 mg/kg twice daily should be considered in patients with BMI ≥ 40 kg/m2, and no dose capping of dalteparin and tinzaparin should be applied for body weight < 140 kg. As regards NOAC, rivaroxaban, apixaban, or dabigatran may be used as thromboprophylaxis in patients with BMI < 40 kg/m2 (n = 4 studies), whereas rivaroxaban and apixaban may be administered to obese patients with VTE or AF, including BMI > 40 kg/m2, at standard fixed-dose (n = 20 studies). The limited available evidence on fondaparinux (n = 3 studies) indicated that the treatment dose should be increased to 10 mg once daily in patients weighing > 100 kg.

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Section: Low-molecular-weight Heparin Used For Treatmentmentioning

confidence: 99%

Dosage of Anticoagulants in Obesity: Recommendations Based on a Systematic Review

Abildgaard

Madsen

Hvas

2020

Semin Thromb Hemost

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“…One study examined 99 adult patients on treatment enoxaparin to determine if anti-Xa monitoring was necessary in the obese population. 19 It was noted that for safety and potential efficacy purposes, anti-Xa should be monitored in this patient population, although clinical outcomes related to anti-Xa monitoring are controversial. In a case series conducted by Ahuja et al, underweight and renally impaired adult patients were subtherapeutic with their first anti-Xa level and often required dose increases to achieve appropriate levels.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of anticoagulant monitoring in pediatric patients receiving enoxaparin for venous thrombosis treatment

Koury

Hellinga

Rose

et al. 2020

Preprint

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Background A venous thromboembolism (VTE) is a blood clot that occurs secondary to vessel wall injury often from a central line insertion. Enoxaparin is often considered a first line treatment in pediatrics for VTE due to its favorable kinetic profile. Enoxaparin monitoring for pediatric patients is accomplished through anti-Xa monitoring although a correlation of efficacy and safety as yet to be established. The objective of this study is to evaluate covariates in pediatric patients to determine which variables are most likely to be associated with enoxaparin dose changes. Methods A single center, retrospective chart review was conducted in pediatric patients treated with enoxaparin for VTE over a 10-year period were assessed to determine covariates that lead to dose changes based off anti-Xa levels. Secondary outcomes described monitoring patterns at the University of New Mexico Children's Hospital. Results Sixty eight patients met inclusion criteria in which results showed that patients aged 2-5.9 months (p=0.026), critical care status (p=0.009), and of Native American ethnicity (p = 0.016) were likely to have an enoxaparin dose change at least once during their treatment regimen. The mean number of levels drawn were 7.5 per patient and doses were not frequently changed based off a confirmatory lab draw. However, many doses were adjusted based off the week 1 post therapeutic level. Conclusion In conclusion, we found that patients of Native American ethnicity, younger than 6 months, and those admitted to the pediatric intensive care unit were likely to have dose changes based on anti-Xa levels.

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“…The younger age and correlating higher creatinine clearance may have contributed to the lower anti-Xa levels in these patients. 36 Lee et al 37 analyzed patients with a mean BMI of 50.6 kg/m 2 (range 40-95.1 kg/m 2 ) and a mean TBW of 146 kg (range 78-249 kg). 37 The majority of patients had supratherapeutic anti-Xa concentrations (>1.1 IU/mL).…”

Section: Prophylaxismentioning

confidence: 99%

“…36 Lee et al 37 analyzed patients with a mean BMI of 50.6 kg/m 2 (range 40-95.1 kg/m 2 ) and a mean TBW of 146 kg (range 78-249 kg). 37 The majority of patients had supratherapeutic anti-Xa concentrations (>1.1 IU/mL). No documented bleeding events occurred in the patients.…”

Section: Prophylaxismentioning

confidence: 99%

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

Sebaaly

Covert²

2018

Ann Pharmacother

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Patients at extremes of weight require special consideration to determine appropriate enoxaparin doses. Specifically, low-body-weight patients may benefit from 30 mg subcutaneously daily for VTE prophylaxis, and standard weight-based dosing for VTE treatment. Conversely, in patients with BMIs ≥40 kg/m, 40 mg subcutaneously twice daily is recommended, with consideration for higher doses in patients with BMIs ≥50 kg/m.

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Monitoring Enoxaparin with Antifactor Xa Levels in Obese Patients

Cited by 24 publications

References 21 publications

Dosage of Anticoagulants in Obesity: Recommendations Based on a Systematic Review

Dosage of Anticoagulants in Obesity: Recommendations Based on a Systematic Review

Evaluation of anticoagulant monitoring in pediatric patients receiving enoxaparin for venous thrombosis treatment

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

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