1020: THERAPEUTIC ENOXAPARIN IN MORBIDLY OBESE PATIENTS: SINGLE-CENTER EXPERIENCE

Abstract

Introduction: Enoxaparin is a low molecular weight heparin commonly used in the treatment of venous thromboembolisms (VTEs); however, evidence on optimal therapeutic dosing recommendations and bleeding adverse events are lacking in patients with morbid obesity (BMI > 35). Recommendation for VTE is 1 mg/kg every 12 hours using total body weight (TBW) for all patients. Methods: We performed a retrospective chart review of patients who were admitted to the ICU between 1/2020 and 9/2021 and were treated for VTE with 1 mg/kg TBW enoxaparin (full dose, FD) to look at bleeding complication rates in patients with BMI >35 and compared with patients who received 0.5 – 0.8 mg/kg TBW (adjusted dose, AD) and BMI > 35. Bleeding complications rates were defined as: needing one or more unit RBC transfusion (RBC), intracranial hemorrhage (ICH), retroperitoneal hemorrhage (RPH), or GI bleed (GIB). The following data were also collected from electronic medical records: Gender (Male), anti-Xa checked (AX), BMI (kg/m2), acute kidney injury (AKI based on KDIGO definitions), and hospital mortality. Results: We identified a total of 55 patients (42 in FD group and 13 in AD group). Compared to AD group, the FD group had more RBC transfusions (50% vs 31%), more ICH (7% vs 0 %), more RPH (9.5% vs 0 %), and more GIB (2.4 % vs 0%) respectively. Both groups were comparable regarding gender (M: 52 vs 38%, p = 0.4), anti-Xa (64% vs 62%, p = 0.9), BMI (44 +/- 7 vs 47 +/- 15, p = 0.3), AKI (17 % vs 15 %, p = 0.7), and mortality (29 % vs 31 %, p = 0.9). Conclusions: These data suggest that enoxaparin at recommended dosing of 1 mg/kg every 12 hours using total body weight for obese patients with BMI > 35 is associated with increased bleeding complications. These findings should be investigated in large multicenter prospective studies.