Assessment of anti-factor Xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patients
Background: Venous thromboembolism (VTE) can be encountered by 60% of hospitalized patients. Anticoagulants have been recommended to reduce the risk of VTE in patients with risk factors. However, no specific dosing recommendations for obese patients are provided in the current practice guidelines. T...
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doaj-08efcd7fa806421d8dcae1b13e5a61d22020-11-24T23:07:12ZengWolters Kluwer Medknow PublicationsAnnals of Thoracic Medicine1817-17371998-35572017-01-0112319920310.4103/atm.ATM_31_17Assessment of anti-factor Xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patientsNouf Al OtaibZohour BootahMaha A Al AmmariTariq M AldebasiAbdulmalik M AlkatheriShmeylan A Al HarbiSalah M AbuRuzAbdulkareem M AlBekairyBackground: Venous thromboembolism (VTE) can be encountered by 60% of hospitalized patients. Anticoagulants have been recommended to reduce the risk of VTE in patients with risk factors. However, no specific dosing recommendations for obese patients are provided in the current practice guidelines. The purpose of this study was to determine the efficacy and safety of weight-based dosing of enoxaparin for VTE prophylaxis among morbidly obese patients undergoing surgery. Methods: Adult patients were enrolled if they have a body mass index (BMI) of ≥35 kg/m2 and were scheduled for surgery. These patients were prescribed enoxaparin (0.5 mg/kg subcutaneously [SC] once daily). Peak anti-factor Xa levels were measured 4 h after the third dose of enoxaparin. The primary outcome measure was to determine whether a weight-based dosing of enoxaparin of 0.5 mg/kg produce the anticipated peak anti-Xa levels (0.2–0.6 IU/m) among obese patients undergoing surgery. Secondary outcomes include the incidence of VTE, the incidence of minor or major bleeding, and the incidence of heparin-induced thrombocytopenia (HIT). Results: Fifty patients were enrolled in the study. The mean age was 53 ± 16 years, 74% of the patients were female. The mean BMI was 40.5 ± 5, and the average enoxaparin dose was 50 ± 9.8 SC daily. Nearly 88% of the patients reached the target anti-factor Xa (0.427 ± 0.17). None of the patients developed HIT or VTE. There was no incidence of major or minor bleeding. Conclusions: Weight-based enoxaparin dose led to the anticipated peak anti-Xa levels (0.2–0.6 IU/mL) in most of the morbidly obese study patients undergoing surgery without any evidence of major side effects. The weight-based dosing of enoxaparin was also effective in preventing VTE in all patients. Although these results are promising, further comparative trials are needed in the setting of morbidly obese surgical patients.http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2017;volume=12;issue=3;spage=199;epage=203;aulast=AlLow molecular weight heparinobesesurgeryvenous thromboembolismweight-based dose |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nouf Al Otaib Zohour Bootah Maha A Al Ammari Tariq M Aldebasi Abdulmalik M Alkatheri Shmeylan A Al Harbi Salah M AbuRuz Abdulkareem M AlBekairy |
spellingShingle |
Nouf Al Otaib Zohour Bootah Maha A Al Ammari Tariq M Aldebasi Abdulmalik M Alkatheri Shmeylan A Al Harbi Salah M AbuRuz Abdulkareem M AlBekairy Assessment of anti-factor Xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patients Annals of Thoracic Medicine Low molecular weight heparin obese surgery venous thromboembolism weight-based dose |
author_facet |
Nouf Al Otaib Zohour Bootah Maha A Al Ammari Tariq M Aldebasi Abdulmalik M Alkatheri Shmeylan A Al Harbi Salah M AbuRuz Abdulkareem M AlBekairy |
author_sort |
Nouf Al Otaib |
title |
Assessment of anti-factor Xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patients |
title_short |
Assessment of anti-factor Xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patients |
title_full |
Assessment of anti-factor Xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patients |
title_fullStr |
Assessment of anti-factor Xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patients |
title_full_unstemmed |
Assessment of anti-factor Xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patients |
title_sort |
assessment of anti-factor xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patients |
publisher |
Wolters Kluwer Medknow Publications |
series |
Annals of Thoracic Medicine |
issn |
1817-1737 1998-3557 |
publishDate |
2017-01-01 |
description |
Background: Venous thromboembolism (VTE) can be encountered by 60% of hospitalized patients. Anticoagulants have been recommended to reduce the risk of VTE in patients with risk factors. However, no specific dosing recommendations for obese patients are provided in the current practice guidelines. The purpose of this study was to determine the efficacy and safety of weight-based dosing of enoxaparin for VTE prophylaxis among morbidly obese patients undergoing surgery.
Methods: Adult patients were enrolled if they have a body mass index (BMI) of ≥35 kg/m2 and were scheduled for surgery. These patients were prescribed enoxaparin (0.5 mg/kg subcutaneously [SC] once daily). Peak anti-factor Xa levels were measured 4 h after the third dose of enoxaparin. The primary outcome measure was to determine whether a weight-based dosing of enoxaparin of 0.5 mg/kg produce the anticipated peak anti-Xa levels (0.2–0.6 IU/m) among obese patients undergoing surgery. Secondary outcomes include the incidence of VTE, the incidence of minor or major bleeding, and the incidence of heparin-induced thrombocytopenia (HIT).
Results: Fifty patients were enrolled in the study. The mean age was 53 ± 16 years, 74% of the patients were female. The mean BMI was 40.5 ± 5, and the average enoxaparin dose was 50 ± 9.8 SC daily. Nearly 88% of the patients reached the target anti-factor Xa (0.427 ± 0.17). None of the patients developed HIT or VTE. There was no incidence of major or minor bleeding.
Conclusions: Weight-based enoxaparin dose led to the anticipated peak anti-Xa levels (0.2–0.6 IU/mL) in most of the morbidly obese study patients undergoing surgery without any evidence of major side effects. The weight-based dosing of enoxaparin was also effective in preventing VTE in all patients. Although these results are promising, further comparative trials are needed in the setting of morbidly obese surgical patients. |
topic |
Low molecular weight heparin obese surgery venous thromboembolism weight-based dose |
url |
http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2017;volume=12;issue=3;spage=199;epage=203;aulast=Al |
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