Abstract
Background: Prophylaxis with fixed doses of low-molecular-weight heparin (LMWH) is standard procedure to reduce the risk of venous thromboembolism after surgery. Patient studies have rarely been stratified for body weight. There is evidence to suggest that lack of sufficient levels of anti-factor X a-activity (anti-Xa) in morbidly obese patients on LMWH. Anti-Xa is used as a measurement of antithrombotic activity. The objective of the present study was to see, for obese patients, whether body weight-adjusted dosing of enoxaparin results in anti-Xa levels comparable to those of a standard fixed dose of normal weight patients. Material and Methods: Subcutaneous injections of enoxaparin 0.3 mg/kg and 0.6 mg/kg were administered to 10 morbidly obese volunteers (median body weight 127 kg). Plasma anti-Xa was measured at defined intervals for 10 hours after injection. Reference values for anti-Xa were obtained from a former study where a fixed dose of 40 mg enoxaparin was given to subjects with different body weights. Results: Body weight dosing with 0.6 mg/kg enoxaparin yields levels of anti-Xa in the same range as in normal weight patients who receive the recommended fixed dose of 40 mg. Conclusion: Body weight-adjusted dosing may be considered in perioperative thromboprophylaxis with LMWH in obese patients.
Highlights
Venous thromboembolism is one of the major causes of mortality after surgery and one of the strongest patient-specific risk factors is obesity, a factor rapidly becoming more prevalent
Prophylaxis with fixed doses of low-molecular-weight heparin (LMWH) is standard procedure to reduce the risk of venous thromboembolism after surgery
Retrospective analyses have reported an incidence of fatal pulmonary embolism after obesity surgery of 0.2–0.3% (Eriksson et al, 1997, Sapala et al, 2003)
Summary
Venous thromboembolism is one of the major causes of mortality after surgery and one of the strongest patient-specific risk factors is obesity, a factor rapidly becoming more prevalent. Prophylaxis with fixed doses of low-molecular-weight heparin (LMWH) is standard procedure to reduce the risk of venous thromboembolism after surgery. The objective of the present study was to see, for obese patients, whether body weight-adjusted dosing of enoxaparin results in anti-Xa levels comparable to those of a standard fixed dose of normal weight patients. Reference values for anti-Xa were obtained from a former study where a fixed dose of 40 mg enoxaparin was given to subjects with different body weights. Results: Body weight dosing with 0.6 mg/kg enoxaparin yields levels of anti-Xa in the same range as in normal weight patients who receive the recommended fixed dose of 40 mg. Conclusion: Body weight-adjusted dosing may be considered in perioperative thromboprophylaxis with LMWH in obese patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
