Dosing of Enoxaparin for Venous Thromboembolism Prophylaxis in Obese Patients

• Published in: Annals of Pharmacotherapy Vol. 47; no. 12; pp. 1717 - 1720
• Main Authors: Willett, Kristine C., Alsharhan, Mohammad, Durand, Cheryl, Cooper, Maryann R.
• Format: Book Review Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-12-2013; Whitney
• Subjects: Anticoagulants - administration & dosage; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Enoxaparin - administration & dosage; Humans; Medical sciences; Metabolic diseases; Obesity; Obesity - drug therapy; Pharmacology. Drug treatments; Venous Thromboembolism - prevention & control; enoxaparin; obesity; thromboprophylaxis; Human; Obesity; Nutrition disorder; Deep vein thrombosis; Cardiovascular disease; Low molecular weight heparin; Anticoagulant; Posology; Enoxaparin sodium; Venous disease; Vascular disease; Prevention; Antithrombotic agent; Venous thrombosis; Thromboembolism; Nutritional status
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1177/1060028013507902

Objective: To evaluate the appropriate dosing of enoxaparin as a venous thromboembolism (VTE) prophylaxis in hospitalized obese patients. Data Sources: Literature articles were accessed through MEDLINE (1946 to August week 1, 2013) and EMBASE (1980 to 2013 week 33) searches using the terms enoxaparin, obesity, and thromboprophylaxis. Study Selection and Data Extraction: All articles that involved human subjects and were published in the English language, evaluating the appropriate dose of enoxaparin for VTE prophylaxis in hospitalized, obese patients were included. Data Synthesis: Appropriate enoxaparin dosing for thromboprophylaxis in adult patients is 40 mg subcutaneously daily or 30 mg subcutaneously twice daily. Although obesity is considered one of the risk factors for thromboembolism, morbidly obese patients were excluded from most clinical trials; therefore, the appropriate enoxaparin preventive dose is not clear in this population. In recent years, the appropriate dose of enoxaparin for VTE prophylaxis in obese patients has been evaluated in 3 clinical studies. All studies enrolled patients with various risk factors for thromboembolism and evaluated different enoxaparin dosing regimens. End point analyses were all based on anti-Xa levels. Conclusions: Due to a lack of well-designed prospective, randomized control studies, varying doses of enoxaparin are used for VTE prophylaxis in hospitalized, obese patients. All doses studied were monitored using anti-Xa levels. Patient follow-up was of short duration in all studies and did not show long-term effectiveness of enoxaparin. Prospective, randomized controlled studies are warranted to show efficacy and safety of one dosage regimen over another.