Review of current evidence available for guiding optimal Enoxaparin prophylactic dosing strategies in obese patients—Actual Weight-based vs Fixed

He, Zikai; Morrissey, Hana; Ball, Patrick

doi:10.1016/j.critrevonc.2017.03.022

Cited by 15 publications

(15 citation statements)

References 19 publications

(17 reference statements)

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“…The effectiveness of a fixed-dose enoxaparin strategy for VTE prophylaxis has been questioned by many experts, who recommended either weight-based dosing regimens or realtime monitoring of AFXa levels as alternatives. 20,23 Although the majority of patients in our study had a peak AFXa level consistent with adequate VTE prophylaxis using a fixed-dose strategy, our patients' weights were within a relatively narrow range: 30 to 57 kg for males and 30 to 45 kg for females.…”

Section: Discussionmentioning

confidence: 83%

“…The higher rate of adequate prophylaxis observed in females could be explained by their lower body water content and plasma volume compared to males. 23 As a sodium salt, enoxaparin is a hydrophilic compound that distributes primarily into the vascular space. 10,24 Accordingly, enoxaparin would be more concentrated in smaller aqueous environments, such as blood.…”

Section: Discussionmentioning

confidence: 99%

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Anti-Factor Xa Levels in Low-weight Surgical Patients Receiving Enoxaparin for Venous Thromboembolism Prophylaxis: A Prospective Cohort Study

Hakeam

Duhailib

Alsemari

et al. 2020

Clin Appl Thromb Hemost

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Enoxaparin is indicated for thromboprophylaxis in non-orthopedic surgical patients at a fixed dose of 40 mg daily. According to the US Food and Drug Administration’s enoxaparin prescribing information, this dose exposes low-weight patients (males < 57 kg, females < 45 kg) to a higher risk of bleeding. This study aimed to determine the rate of achieving a prophylactic peak anti-factor Xa (AFXa) level in low-weight surgical patients using enoxaparin 30 mg daily. Low-weight patients admitted for abdominopelvic or noncardiac thoracic surgery from May 2018 to May 2019 were prospectively studied. After receiving daily enoxaparin 30 mg, peak AFXa levels were assessed for achieving a prophylactic level (0.2-0.5 IU/mL). In 121 patients, the proportion of achieving a prophylactic peak AFXa level was 66.1%. More females (84.8%) achieved a prophylactic level compared to males (54.7%, P = .001). All out-of-range peak AFXa levels (33.9%) were sub-prophylactic. The median peak AFXa level was lower in males (0.24 [0.1-0.47] IU/mL) than females (0.31 [0.1-0.5] IU/mL; P < .001). On univariate analysis, female sex and weight were associated with achieving a prophylactic peak AFXa level. On multivariate analysis, only female sex was independently associated with an adequate prophylactic AFXa level (odds ratio 3.17, 95% CI: 1.32-11.94; P = .014). Four venous thromboembolism events (3.3%) were observed in patients with sub-prophylactic peak AFXa levels (9.7%). Two-thirds of low-weight surgical patients achieved a prophylactic peak AFXa level using daily enoxaparin 30 mg. This dose is likely to provide adequate thromboprophylaxis in low-weight females.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Anti-Factor Xa Levels in Low-weight Surgical Patients Receiving Enoxaparin for Venous Thromboembolism Prophylaxis: A Prospective Cohort Study

Hakeam

Duhailib

Alsemari

et al. 2020

Clin Appl Thromb Hemost

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“…Despite this, the physicians interviewed prefer LMWHs over DOACs for thromboprophylaxis of obese patients. A recent pooled data analysis from 11 out of 14 primary studies highlighted the advantages of weight-based or higher-than-fixed dosing of enoxaparin, which increased the probability of achieving desired anti-Xa levels [81]. However, due to insufficient evidence and quality of studies on LMWH dose adjustment, caution should be taken in patients with a weight > 120–125 kg [81].…”

Section: Methodsmentioning

confidence: 99%

“…A recent pooled data analysis from 11 out of 14 primary studies highlighted the advantages of weight-based or higher-than-fixed dosing of enoxaparin, which increased the probability of achieving desired anti-Xa levels [81]. However, due to insufficient evidence and quality of studies on LMWH dose adjustment, caution should be taken in patients with a weight > 120–125 kg [81]. Indeed, in the UK, NICE have highlighted the need for further research regarding dose strategies for obese patients before recommendations can be made [56].…”

Section: Methodsmentioning

confidence: 99%

Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients

et al. 2019

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BackgroundVenous thromboembolism (VTE) accounts for an estimated 900,000 cases per year in the US alone and constitutes a considerable burden on healthcare systems across the globe.ObjectiveTo understand why the burden is so high, qualitative and quantitative research was carried out to gain insights from experts, guidelines and published studies on the unmet clinical needs and therapeutic strategies in VTE prevention and treatment in three populations identified as being at increased risk of VTE and in whom VTE prevention and treatment were regarded as suboptimal: pregnant women, the elderly and obese patients.MethodologyA gap analysis methodology was created to highlight unmet needs in VTE management and to discover the patient populations considered most at risk. A questionnaire was devised to guide qualitative interviews with 44 thrombosis and haemostasis experts, and a review of the literature on VTE in the specific patient groups from 2015 to 2017 was completed. This was followed by a Think Tank meeting where the results from the research were discussed.ResultsThis review highlights the insights gained and examines in detail the unmet needs with regard to VTE risk-assessment tools, biomarkers, patient stratification methods, and anticoagulant and dosing regimens in pregnant women, the elderly and obese patients.ConclusionsSpecifically, in pregnant women at high risk of VTE, low-molecular-weight heparin (LMWH) is the therapy of choice, but it remains unclear how to use anticoagulants when VTE risk is intermediate. In elderly patients, evaluation of the benefit of VTE prophylaxis against the bleeding risk is particularly important, and a head-to-head comparison of efficacy and safety of LMWH versus direct oral anticoagulants is needed. Finally, in obese patients, lack of guidance on anticoagulant dose adjustment to body weight has emerged as a major obstacle in effective prophylaxis and treatment of VTE.

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“…Obez hastalarda doz ayarlamasının sabit doz uygulamasına üstünlüğü gösterilememiştir. [52] AAOS kılavuzu herhangi bir farmakolojik ajan için bir öneride bulunmazken; ACCP, VTE profilaksisinde DMAH'leri temel ilaç olarak belirlemiştir. [3] Bu ilaçların ortopedik cerrahi hastaların tromboprofilaksisinde etkili ve güvenli olduklarını gösteren çok sayıda ve güçlü kanıtlar içeren çalışma bulunmaktadır.…”

Section: Antitromboembolik çOraplar (Kompresyon Varis çOrapları)unclassified

Derin ven trombozu ve pulmoner emboli

Özcan¹,

Biçer²,

Taşkıran³

2019

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Review of current evidence available for guiding optimal Enoxaparin prophylactic dosing strategies in obese patients—Actual Weight-based vs Fixed

Cited by 15 publications

References 19 publications

Anti-Factor Xa Levels in Low-weight Surgical Patients Receiving Enoxaparin for Venous Thromboembolism Prophylaxis: A Prospective Cohort Study

Anti-Factor Xa Levels in Low-weight Surgical Patients Receiving Enoxaparin for Venous Thromboembolism Prophylaxis: A Prospective Cohort Study

Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients

Derin ven trombozu ve pulmoner emboli

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