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Updated: Jun 4, 2026
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Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
Increased enoxaparin dosing is required for obese children
Teresa V Lewis1, Peter N Johnson, Ashley M Nebbia
1Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, PO Box 26901, Oklahoma City, OK 73126-0901, USA. teresa-lewis@ouhsc.edu
Pediatrics
|February 16, 2011
Summary
Obese adolescents may require higher enoxaparin doses than standard recommendations for effective venous thromboembolism (VTE) prophylaxis. Further studies are needed to establish optimal dosing for this population.
Area of Science:
- Pediatric Pharmacology
- Thrombosis and Hemostasis
Background:
- Current guidelines recommend weight-based enoxaparin dosing for venous thromboembolism (VTE) prophylaxis in children.
- The American College of Chest Physicians (ACCP) suggests 0.5 mg/kg every 12 hours for pediatric VTE prophylaxis.
- No definitive upper enoxaparin dose limit exists for pediatric VTE prophylaxis.
Observation:
- Three obese adolescent males required enoxaparin doses exceeding adult recommendations to achieve target anti-factor Xa levels (0.1-0.3 IU/mL).
- Doses varied significantly based on individual patient factors, with requirements exceeding 0.28 mg/kg, 0.15 mg/kg, and 0.49 mg/kg respectively.
- Enoxaparin administered every 12 hours achieved therapeutic anti-factor Xa levels in all patients without VTE events.
Findings:
- Obese adolescents may need higher enoxaparin doses than currently recommended for VTE prophylaxis.
- Individualized dosing is crucial due to variability in patient response and pharmacokinetic unpredictability.
- Therapeutic anti-factor Xa levels were achieved with every 12-hour dosing in these cases.
Implications:
- Higher enoxaparin doses may be necessary for VTE prophylaxis in obese pediatric patients.
- Prospective studies are essential to determine precise dosing strategies for this specific population.
- Understanding pharmacokinetic variability is key to optimizing enoxaparin therapy in obese adolescents.
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