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Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
Enoxaparin Venous Thromboembolism Prophylaxis Dosing in Critically Ill Underweight Patients
Elizabeth Curcio1, Alyssa S Meester1, Angela Harding1
1OhioHealth Riverside Methodist Hospital, Columbus, OH, USA.
Insights
Enoxaparin dosing for underweight patients showed no significant difference in major bleeding events or VTE incidence. Further research is needed to determine optimal VTE prophylaxis for this population.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Thrombosis Research
Background:
- Optimal venous thromboembolism (VTE) prophylaxis dosing in underweight patients is not well-established.
- Existing evidence is insufficient to guide enoxaparin dosing for patients with a body mass index (BMI) below 18.5 kg/m².
- This study addresses the critical need for data on VTE prophylaxis in this specific patient group.
Purpose of the Study:
- To compare the incidence of major bleeding events in underweight patients receiving different prophylactic doses of enoxaparin.
- To evaluate the safety and efficacy of 30 mg versus 40 mg daily subcutaneous enoxaparin for VTE prophylaxis in critically ill underweight adults.
- To identify optimal enoxaparin dosing strategies for VTE prevention in underweight patient populations.
Main Methods:
- Retrospective analysis of data from multiple hospitals within a single healthcare system.
- Inclusion criteria: adult patients with BMI < 18.5 kg/m², ICU admission ≥ 48 hours, and receipt of enoxaparin for VTE prophylaxis.
- Patients were divided into two groups based on enoxaparin dose: 30 mg once daily or 40 mg once daily.
Main Results:
- A total of 310 underweight patients were analyzed (80 in the 30 mg group, 230 in the 40 mg group).
- No statistically significant difference was observed in the incidence of major bleeding events between the 30 mg and 40 mg enoxaparin groups (P = 0.61).
- Secondary outcomes including VTE incidence, ICU length of stay, hospital length of stay, and 30-day all-cause mortality also showed no significant differences between the groups.
Conclusions:
- Current evidence suggests that both 30 mg and 40 mg once-daily subcutaneous enoxaparin doses result in similar rates of clinically significant bleeding in underweight, critically ill patients.
- The study did not find a difference in VTE incidence or other key clinical outcomes between the two enoxaparin dosing strategies.
- Further research is warranted to establish definitive optimal enoxaparin dosing for VTE prophylaxis in underweight patient populations.
Abstract:
Purpose: Optimal dosing of VTE prophylaxis for specific patient populations remains an area of concern as insufficient evidence exists regarding dosing for underweight patients. The purpose of this study is to compare the incidence of major bleeding events in underweight patients given different prophylactic doses of enoxaparin. Methods: This is a retrospective analysis performed at multiple hospitals within a single health care system. Patients with a BMI < 18.5 kg/m2 were divided into 2 groups depending on whether they received at least 1 prophylactic dose of enoxaparin 30 mg subcutaneously once daily or enoxaparin 40 mg subcutaneously once daily. Underweight adult patients were included if they were admitted to an ICU for at least 48 hours and received at least 1 dose of enoxaparin for VTE prophylaxis during their ICU admission. The primary aim was to compare the incidence of clinically significant bleeding between dosing strategies. Secondary aims included the incidence of VTE during admission, ICU length of stay, overall hospital length of stay, and all-cause mortality 30 days post-discharge. Results: A total of 310 patients met inclusion criteria for this study, with 80 patients in the 30 mg group and 230 patients in the 40 mg group. There was no significant difference in major bleeding events between the 2 groups (P = .61). No significant differences in incidence of VTE (P = .455 ), ICU length of stay (P = .466), overall hospital stay (P = .502), or all-cause mortality (P = .925) were found between groups. Conclusions: No difference was found in clinically significant bleeding between underweight critically ill patients receiving VTE prophylaxis with enoxaparin 30 mg once daily or 40 mg once daily. Further studies are needed to evaluate the optimal dosing of VTE prophylaxis with enoxaparin in underweight patients.
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