Anti-Xa activity after enoxaparin prophylaxis in hospitalized patients weighing less than fifty-five kilograms

Low-molecular-weight heparins are commonly used for the prophylaxis of thromboembolic disease. In contrast to therapeutic doses, recommended prophylactic doses are fixed (i.e., 40 mg/day enoxaparin). Dosing of patients with extreme body weights has not been well studied, especially dosing of low weight patients.

To establish the anti-Xa activity that results from 40 mg/day enoxaparin in inpatients with body weight ≤ 55 kg.

Cross-sectional study including inpatients older than 18 years, with body weight ≤ 55 kg, and whose treating physician found indication for 40 mg/day enoxaparin. We excluded patients with renal failure and those using oral anticoagulants. Anti-Xa activity was measured 3 hours after the second dose of enoxaparin. Statistical analyses were conducted to determine the effect of body weight on anti-Xa levels.

Average age was 72.5 years (interquartile range, 30) and median body weight was 49.7 kg (interquartile range, 7). Twenty-five percent of patients weighed ≤ 45 kg, 37.5% weighed 46-50 kg, and 37.5% weighed 51-55 kg. The mean anti-Xa activity was 0.54±0.18IU/ml, and 60% of the patients exhibited activity ≥0.5 IU/ml. Weight and anti-Xa activity inversely correlated (Spearman's rho=-0.428, p=0.001). Patients weighing ≤ 45 kg exhibited higher anti-Xa activity (0.61±0.18 IU/ml, p=0.008) than heavier patients and an odds ratio of 8 for anti-Xa level ≥0.5IU/ml (95% CI: 1.42-45.06).

Anti-factor Xa activity rises significantly when body weight decreases. Patients of low weight, especially those weighing <45 kg, exhibited an anti-Xa activity higher than the desired range for thromboembolic prophylaxis.