Clinical Drug Investigation 2019-Oct
Stratifying Therapeutic Enoxaparin Dose in Morbidly Obese Patients by BMI Class: A Retrospective Cohort Study.
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BACKGROUND
Enoxaparin is a low-molecular weight heparin (LMWH) commonly used for treatment of venous thromboembolism and acute coronary syndromes. The recommended dose for these conditions is weight-based (1 mg/kg) and doesn't require dose-capping. However, previous studies have shown that in those with a body mass index (BMI) > 40 kg/m2, this dose results in supratherapeutic levels.RESULTS
Two hundred forty-one patients were included in the study, and 132 achieved a therapeutic dose. For those with a BMI of 40-50 kg/m2, the median therapeutic dose was 0.97 mg/kg every 12 h. In subjects with a BMI of 50-60 kg/m2, the median therapeutic dose was 0.70 mg/kg. Finally, the median therapeutic dose for subjects with a BMI over 60 kg/m2 was 0.71 mg/kg. In all three groups, 53-65% of patients had a supratherapeutic anti-Xa level while less than 10% had a subtherapeutic level. Relatively few patients (4.1%) experienced major bleeding and only one thromboembolic event was reported.