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Updated: Jun 17, 2025
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Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
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Therapeutic Enoxaparin Dosing in Obesity
Marcelle Appay1,2, Shreyas Kharadi1, Sajani Nanayakkara1
1School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
The Annals of Pharmacotherapy
|August 7, 2024
Summary
This review found insufficient evidence for optimal enoxaparin dosing in obese patients. Antifactor Xa (AFXa) monitoring may guide therapy, but further research is needed for a definitive dosing regimen.
Area of Science:
- Pharmacology
- Clinical Medicine
- Obesity Medicine
Background:
- Enoxaparin is a widely used anticoagulant.
- Obesity presents unique challenges in pharmacotherapy due to altered drug distribution and metabolism.
- Optimal therapeutic enoxaparin dosing in obese patients remains unclear.
Purpose of the Study:
- To systematically review existing data on the efficacy and safety of therapeutic enoxaparin in obese patients.
- To identify research gaps regarding enoxaparin dosing strategies for obesity.
Main Methods:
- Systematic literature search of Medline and Embase databases up to December 20, 2023.
- Inclusion of studies reporting therapeutic enoxaparin dosing, bleeding, thrombotic outcomes, or antifactor Xa (AFXa) monitoring in obese adults.
- Data extraction and study selection managed using Covidence, with reference list screening for additional studies.
Main Results:
- Sixteen studies were included, exhibiting significant heterogeneity in doses, indications, and designs.
- Thrombotic events occurred in a median of 1.3% of patients, while bleeding events occurred in a median of 5.7%.
- Conflicting results were observed regarding the influence of body mass index (BMI) and weight-based dosing on AFXa levels, with one study suggesting actual body weight dosing predicts supratherapeutic levels.
Conclusions:
- Heterogeneity across studies precludes establishing an optimal enoxaparin dosing strategy for obese patients.
- Antifactor Xa (AFXa) monitoring may be a valuable tool for guiding enoxaparin dosage in this population.
- Further research is essential to determine appropriate and effective enoxaparin dosing regimens for obese individuals.
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