Evaluation of a Treatment-Dose Enoxaparin Protocol for Patients With Obesity

Treatment-dose enoxaparin is not well studied in obese patients. Guidelines suggest that obese patients receiving enoxaparin therapy for acute venous thromboembolism (VTE) should receive a standard initial dose, 1 mg/kg, based on actual body weight. It is possible that this dosing strategy in obese patients may be overestimated, leading to a higher bleeding risk compared to non-obese patients.

To gather data regarding enoxaparin treatment dosing and anti-Xa level monitoring in patients who are obese to guide dose adjustments.

A single-center, retrospective chart review that included patients who were ordered treatment-dose enoxaparin and had a BMI ≥ 40 kg/m², which resulted in an automatic pharmacy consult.The primary endpoint of this study was incidence of bleeding.

The analysis included 102 patients. Most patients (92.1%) had a BMI of ≥ 40-60 kg/m² while 7.8% of patients had a BMI of > 60 kg/m². The average initial and final doses were 1.0 ± 0.1 mg/kg and 0.9 ± 0.2 mg/kg, respectively. The incidence of bleeding was 4.9%. The average dose for those that bled was 0.7 ± 0.1 mg/kg. On average, patients who bled had higher BMIs than patients who did not bleed (51.6 kg/m² vs. 48.0 kg/m²). Of the 71 patients with an initial anti-Xa level, 42 of the levels were considered supratherapeutic (59.2%).

A 1 mg/kg starting dose of enoxaparin may be too high for patients who are obese as many patients required an adjustment to their dose after initial anti-Xa levels.