Stratifying Therapeutic Enoxaparin Dose in Morbidly Obese Patients by BMI Class: A Retrospective Cohort Study

Lee, Young R.; Palmere, Peter J.; Burton, Caitlin E.; Benavides, Taylor M.

doi:10.1007/s40261-019-00855-9

Cited by 12 publications

(7 citation statements)

References 17 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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“…[183][184][185] Nos obesos mórbidos, estudos de farmacodinâmica e dados observacionais identificaram a frequente necessidade de ajuste de doses para alcance de meta terapêutica (IMC > 40kg/m 2 ) guiada pela dosagem do fator anti-Xa, sugerindo utilidade do monitoramento quando disponível. 186,187 No entanto, na avaliação de obesos com SCA no registro norte-americano CRUSADE, o uso de enoxaparina em dose padrão (1mg/kg/peso) naqueles com peso > 150kg esteve associado a um maior risco de sangramento em comparação com subgrupo entre 120 e 150kg. (11,4% vs. 5,6%, p < 0,001).…”

Section: Anticoagulantesunclassified

Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST – 2021

Nicolau¹,

Filho²,

Petriz³

et al. 2021

Arquivos Brasileiros De Cardiologia

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“…Thromboprophylaxis in COVID-19 using non-fractionated heparin or low-molecular-weight heparins has been used to control the hypercoagulability state in hospitalized patients [42,43], with multiple pharmacological mechanisms previously described [44,45]. Risk-benefit assessments of anticoagulation therapy should consider individual contraindications, stratification of bleeding risk, and dosage adjustments in patients with renal impairment and obesity [46]. The use of proarrhythmic medications should also be closely monitored.…”

Section: Clinical Implications For Pharmaceutical Carementioning

confidence: 99%

Preparedness of pharmacists to respond to the emergency of the COVID-19 pandemic in Brazil: a comprehensive overview

Martins

Medeiros

Almeida

et al. 2020

Drugs Ther Perspect

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The outbreak of COVID-19 in low-and middle-income countries is worrisome due to the social inequalities in these countries, their limited health budgets and the significant burden of other acute and chronic diseases. The leap in the number of cases in Brazil has imposed a huge strain on the healthcare system. We sought to provide a comprehensive overview of the challenges encountered by pharmacy services in responding to the COVID-19 pandemic emergency in Brazil and discuss the role of clinical pharmacists in this context. Pharmaceutical services play a key role in the emergency response to the pandemic. The pharmacy workforce has been actively working to manage drug shortages, redesign workflow, and review drug formularies/protocols to improve safety for patients and healthcare professionals (HCPs). COVID-19 patients may present high risk in the use of medications and clinical pharmacists can contribute substantially as part of a multidisciplinary team to improve outcomes in drug therapy in severe and critical illness. The participation of pharmacists as members of antimicrobial stewardship programs should be enhanced to ensure appropriate and safe use of antibiotics in this context. HCPs should be encouraged to seek improvements in the performance of pharmaceutical services and innovative practices to respond to the pandemic. Further studies are needed to generate knowledge on COVID-19 to improve patient care in vulnerable populations.

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Stratifying Therapeutic Enoxaparin Dose in Morbidly Obese Patients by BMI Class: A Retrospective Cohort Study

Cited by 12 publications

References 17 publications

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

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

Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST – 2021

Preparedness of pharmacists to respond to the emergency of the COVID-19 pandemic in Brazil: a comprehensive overview

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