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Title: | Weight-Based Enoxaparin for Venous Thromboembolism in Obesity Gives Similar Anti-Xa Levels to Patients <100 kg, with No Increase in Major Bleeding. | Authors: | Tran H.A.;Maclachlan K.H.;Chunilal S.D.;Stevens H.P. | Institution: | (Maclachlan, Stevens, Tran, Chunilal) Department of Clinical Haematology, Monash Medical Centre, Clayton, VIC, Australia | Issue Date: | 6-Mar-2019 | Copyright year: | 2019 | Publisher: | Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com) | Place of publication: | United States | Publication information: | Seminars in Thrombosis and Hemostasis. 45 (1) (pp 94-99), 2019. Date of Publication: 2019. | Journal: | Seminars in Thrombosis and Hemostasis | Abstract: | In trials assessing venous thromboembolism (VTE) treatment, obese patients are under-represented or excluded. The main objective of this article is to examine the safety of weight-based enoxaparin dosing in obesity, as assessed by anti-factor Xa (anti-Xa) activity, bleeding, and recurrence. A 5-year retrospective audit of patients with acute VTE, weighing > 100 kg, prescribed enoxaparin 1 mg/kg twice daily, with an anti-Xa level 2 to 6 hours post-dose. The primary outcome was anti-Xa levels, and the secondary outcomes were bleeding and recurrence. Results were compared with patients weighing < 100 kg (n = 64), and obese patients prescribed doses < 1 mg/kg (n = 28). One-hundred sixty-six patients weighing > 100 kg with VTE were identified, with 64 excluded for not fulfilling criteria. The remaining 102 patients had a median weight of 130 kg (range: 105-222 kg). The median peak anti-Xa level was 0.93 U/mL, with 56% of levels being in the proposed therapeutic range (0.5-1.0 U/mL), 40% > 1.0 U/mL, and 4% < 0.5 U/mL. The median anti-Xa levels and distribution were not significantly different between patients > 100 kg and patients < 100 kg, while obese patients prescribed < 1 mg/kg were more frequently subtherapeutic (21%). Regardless of weight, the majority of patients with moderate renal impairment (eGFR 30-59 mL/min) had an anti-Xa level > 1.0 U/mL (61%). In the obese patients, there was no major bleeding or recurrence within 30 days. In comparison, patients weighing < 100 kg, despite similar peak anti-Xa levels, had higher rates of bleeding and recurrence. This was likely due to their older age and comorbidities, particularly renal impairment and cancer. These data support weight-based dosing of enoxaparin in obesity with no maximum dose, ensuring therapeutic drug levels, with anti-Xa levels suggested in obese patients with clinical risk factors for bleeding.Copyright © 2019 by Thieme Medical Publishers, Inc. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1055/s-0038-1677019 | PubMed URL: | 30630208 [http://www.ncbi.nlm.nih.gov/pubmed/?term=30630208] | ISSN: | 0094-6176 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/36191 | Type: | Article | Subjects: | injury lung embolism major clinical study male malignant neoplasm menorrhagia moderate renal impairment obese patient *obesity postoperative hemorrhage postpartum hemorrhage priority journal recurrent disease retrospective study risk factor *venous thromboembolism/dt [Drug Therapy] *blood clotting factor 10a/ec [Endogenous Compound] *enoxaparin/dt [Drug Therapy] *enoxaparin/pv [Special Situation for Pharmacovigilance] clinically relevant nonmajor bleeding clinical outcome adult aged aging *anticoagulant therapy article *bleeding *body weight comorbidity deep vein thrombosis drug dose reduction drug safety estimated glomerular filtration rate female hematoma human infection deep vein thrombosis drug dose reduction drug safety estimated glomerular filtration rate female hematoma human infection injury lung embolism major clinical study male malignant neoplasm menorrhagia moderate renal impairment obese patient *obesity postpartum hemorrhage priority journal recurrent disease retrospective study risk factor *venous thromboembolism / *drug therapy postoperative hemorrhage aged aging *anticoagulant therapy Article *bleeding *body weight clinical outcome comorbidity adult |
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