Abstract
PurposeVenous thromboembolic events (VTEs) are common complications after bariatric surgery, and enoxaparin is commonly used to prevent VTEs. The risk for VTEs is sex-specific. Whether enoxaparin application results in similar anti-factor Xa activities (aFXa) in males and females with obesity remains to be determined. We investigated whether our dosage regimen of enoxaparin resulted in similar serum aFXa levels in female and male patients undergoing bariatric surgery.Materials and MethodsWe administered enoxaparin twice daily in patients undergoing bariatric surgery. Patients with a body mass index (BMI) > 60 kg/m2 (n = 11) received 60 mg enoxaparin (group 2), and patients with lower BMI (n = 86) received 40 mg per dose (group 1). Peak aFXa levels were measured 3 days after surgery. The primary outcome was the aFXa level. As a secondary outcome, we detected VTEs and major bleeding events and explored the possible influencing factors of aFXa.ResultsWomen had higher aFXa than men, but after matching for anthropometric values, the two groups were similar (females: 0.17 ± 0.08 U/ml; males: 0.18 ± 0.08 U/ml). Linear regression revealed a moderate relationship between weight and aFXa levels. The 3-month follow-up was attended by 94.9%, at which one patient had pulmonary embolism.ConclusionIndividual enoxaparin dosage regimens for men and women do not seem to be required. Weight-based dosing regimen seems to be a more reasonable choice.Graphical abstract
Highlights
Venous thromboembolism (VTE) is a common complication following surgery and is accompanied by a high mortality rate [1]
Five patients had a history of cancer (5.2%), two had previous VTEs (2.1%), and one was paralyzed and had reduced mobility (1%) (Table 1)
Considering the differences in total water, plasma volume, metabolism, muscle content, or adipose tissue distribution between men and women [8], it is natural to assume that men and women have different anti-factor Xa activities (aFXa) levels after enoxaparin application
Summary
Venous thromboembolism (VTE) is a common complication following surgery and is accompanied by a high mortality rate [1]. Risk factors for VTE include surgery, Key Points 1. Males and females have similar aFXa levels 2. Enoxaparin is injected subcutaneously, and all of these factors might be able to influence the anti-factor Xa (aFXa) activity level in a sex-specific way. We investigated whether the application of the same enoxaparin dose leads to similar anti-factor Xa levels in male and female patients with obesity. We sought to determine the possible factors that influence the aFXa level. We detected VTEs and major bleeding events [21] and explored possible influencing factors of aFXa. Bleeding was assessed by clinical evaluation and laboratory tests. We matched male and female patients 1:1 based on weight, BMI, waist circumference, and age. Our institutional review board approved this study
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