Safety and Efficacy of High-Dose Unfractionated Heparin for Prevention of Venous Thromboembolism in Overweight and Obese Patients

Joy, Mishna; Tharp, Eileen; Hartman, Heather; Schepcoff, Sara; Cortes, Jennifer; Sieg, Adam; Mariski, M.; Lee, Yeunju; Murphy, Meghan; Ranjbar, Ghazaleh; Sharaf, Sherouk; Yau, Gin; Choi, H. Alex; Samuel, Sophie

doi:10.1002/phar.1775

Cited by 23 publications

(23 citation statements)

References 26 publications

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“…Because current evidence suggests that the relationship between body mass index (BMI) and incidence of venous thromboembolism (VTE) is linear, the risk for VTE rises as BMI increases . The incidence of VTE was reported to range from 0.1–42% in patients in all BMI subgroups who were either hospitalized (1.43–15%) or seen as outpatients (0.1–42%) . Obesity is suspected to be one of the risk factors for VTE, and the incidence of VTE increases by 6‐fold when BMI exceeds 35 kg/m 2 .…”

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confidence: 99%

“…Based on this study, we were able to calculate the sample size for the current study, which was a follow‐up to the preliminary study, in which we broadened the population to include all hospitalized patients. From these studies and others we inferred that regardless of the UFH dose, there was no significant difference in VTE rates . Given the uncertain role of BMI and its impact on the occurrence of VTE, we then examined the data from all patients hospitalized over a 2‐year time frame in an attempt to increase the sample size.…”

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confidence: 99%

“…[1][2][3][4] The incidence of VTE was reported to range from 0.1-42% in patients in all BMI subgroups who were either hospitalized (1.43-15%) or seen as outpatients (0.1-42%). [1][2][3][4][5][6][7][8][9] Obesity is suspected to be one of the risk factors for VTE, and the incidence of VTE increases by 6-fold when BMI exceeds 35 kg/m 2 . 1 Several studies have investigated the relationship between obesity and VTE.…”

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confidence: 99%

“…From these studies and others we inferred that regardless of the UFH dose, there was no significant difference in VTE rates. 6 Given the uncertain role of BMI and its impact on the occurrence of VTE, we then examined the data from all patients hospitalized over a 2year time frame in an attempt to increase the sample size. The objective of this study was to assess whether a positive linear association exists between BMI and incidence of VTE in overweight and obese hospitalized patients.…”

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confidence: 99%

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Assessment of the Relationship between Body Mass Index and Incidence of Venous Thromboembolism in Hospitalized Overweight and Obese Patients

Samuel

Gomez

Savarraj³

et al. 2017

Pharmacotherapy

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Assessment of the Relationship between Body Mass Index and Incidence of Venous Thromboembolism in Hospitalized Overweight and Obese Patients

Samuel

Gomez

Savarraj³

et al. 2017

Pharmacotherapy

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“…I would like to thank the authors of the recent article “Safety and Efficacy of High‐dose Unfractionated Heparin for Prevention of Venous Thromboembolism in Overweight and Obese Patients” that has contributed more to the body of literature in venous thromboembolism (VTE) prophylaxis for patients with obesity . This study provided evidence against the use of high‐dose unfractionated heparin (UFH) thromboprophylaxis for obese patients.…”

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High-Dose Venous Thromboembolism Prophylaxis for Obese Patients

Turco

Samuel²,

Choi³

2016

Pharmacotherapy

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I would like to thank the authors of the recent article "Safety and Efficacy of High-dose Unfractionated Heparin for Prevention of Venous Thromboembolism in Overweight and Obese Patients" that has contributed more to the body of literature in venous thromboembolism (VTE) prophylaxis for patients with obesity. 1 This study provided evidence against the use of high-dose unfractionated heparin (UFH) thromboprophylaxis for obese patients. These results differ from those of a previous study that found a lower incidence of VTE for patients on high-dose UFH. 2 This conflicting evidence may leave clinicians unsure of how to provide appropriate thromboprophylaxis for obese patients. The conflicting findings of these two studies could be related to differences in study designs and analysis.One of these differences is that patients were compared by body mass index (BMI) every 5 kg/m 2 by the more recent study, whereas the other one compared BMI lower than 40 kg/m 2 to BMI higher than 40 kg/m 2 . Because the latter authors only found a lower incidence of VTE on high-dose thromboprophylaxis for those with a BMI higher than 40 kg/m 2 , would the authors of the more recent study have found a benefit if they had compared all those with a BMI higher than 40 kg/m 2 with all those with a BMI lower than 40 kg/m 2 ?The older trial included enoxaparin 40 mg subcutaneously (SC) twice/day as a high-dose option.There are data that suggest enoxaparin is superior to UFH, with one meta-analysis of randomized controlled trials finding a 37% risk reduction compared with UFH in total VTE for medical patients, with a nonsignificant difference in bleeding. 3 Another study found no significant differences between heparin 7500 units SC every 8 hours compared with 5000 units SC every 8 hours, suggesting that high-dose UFH may not benefit obese patients. 4 However, that study had limitations, such as differences in baseline factors that increased bleeding and VTE risk in the highdose group. Therefore, the inclusion of enoxaparin in the older study as compared with only UFH by the more recent one may have driven the differences in observed outcomes. By including high-dose enoxaparin as a high-dose thromboprophylaxis option and by analyzing the effect of enoxaparin separately from UFH, a benefit may have been found in the more recent study.Because studies like these help increase our understanding in this area, they also lead to further questions. More specific evidence is needed to guide the approach to VTE prophylaxis properly in obese patients. Future studies to decrease the incidence of VTE while minimizing the risk of bleeding should examine the use of high-dose VTE prophylaxis with enoxaparin 40 mg SC twice/day for those with a BMI higher than 40 kg/m 2 . References 1. Joy M, Tharp E, Hartman H, Schepcoff S, et al. Safety and efficacy of high-dose unfractionated heparin for prevention of venous thromboembolism in overweight and obese patients. Pharmacotherapy 2016;36(7):740-8.

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VTE Prophylaxis in General and Orthopedic Surgery

Abdulgawad

Sundaram

Othman

et al. 2019

Precision Anticoagulation Medicine

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Safety and Efficacy of High-Dose Unfractionated Heparin for Prevention of Venous Thromboembolism in Overweight and Obese Patients

Abstract: Administering a higher dose of heparin to patients weighing more than 100 kg may not impart additional efficacy in reducing the incidence of VTE. However, it may increase the risk for bleeding.

Cited by 23 publications

References 26 publications

Assessment of the Relationship between Body Mass Index and Incidence of Venous Thromboembolism in Hospitalized Overweight and Obese Patients

Assessment of the Relationship between Body Mass Index and Incidence of Venous Thromboembolism in Hospitalized Overweight and Obese Patients

High-Dose Venous Thromboembolism Prophylaxis for Obese Patients

VTE Prophylaxis in General and Orthopedic Surgery

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