BACKGROUND: Venous thromboembolism (VTE) is a serious health care issue that affects a large number of people. Few standards exist for delineating the optimal dosing strategy for VTE prevention in obese patients, especially in the setting of major surgery or trauma. OBJECTIVE: To document the efficacy of a surgical intensive care unit (SICU)-specific, weight-based dosing protocol of enoxaparin 0.5 mg/kg given subcutaneously every 12 hours for VTE prophylaxis in morbidly obese (defined as body mass index [BMI] ≥35 kg/m(2) or weight ≥150 kg) SICU patients, using peak anti-factor Xa levels to determine therapeutic endpoints. METHODS: Data were collected retrospectively in an academic, university-based SICU on 23 morbidly obese patients who received weight-based enoxaparin for VTE prophylaxis from December 1, 2008, through June 30, 2010. RESULTS: A weight-based dosage range of enoxaparin 50-120 mg twice daily (median 60) was given to 23 patients. The mean BMI was 46.4 kg/m(2). The initial mean anti-factor Xa level (measured after the third dose) was 0.34 IU/mL (range 0.20-0.59). Patients received an average of 18 doses. Two cases required an increase or decrease in dosage based on anti-factor Xa levels. Morbidity related to this dosing included a single event of minor endotracheal bleeding and a single deep vein thrombosis that was likely present prior to treatment. CONCLUSIONS: Weight-based dosing with enoxaparin in morbidly obese SICU patients was effective in achieving anti-factor Xa levels within the appropriate prophylactic range. This regimen reduced the rate of VTE below expected levels and no additional adverse effects were reported.
BACKGROUND:Venous thromboembolism (VTE) is a serious health care issue that affects a large number of people. Few standards exist for delineating the optimal dosing strategy for VTE prevention in obesepatients, especially in the setting of major surgery or trauma. OBJECTIVE: To document the efficacy of a surgical intensive care unit (SICU)-specific, weight-based dosing protocol of enoxaparin 0.5 mg/kg given subcutaneously every 12 hours for VTE prophylaxis in morbidly obese (defined as body mass index [BMI] ≥35 kg/m(2) or weight ≥150 kg) SICU patients, using peak anti-factor Xa levels to determine therapeutic endpoints. METHODS: Data were collected retrospectively in an academic, university-based SICU on 23 morbidly obesepatients who received weight-based enoxaparin for VTE prophylaxis from December 1, 2008, through June 30, 2010. RESULTS: A weight-based dosage range of enoxaparin 50-120 mg twice daily (median 60) was given to 23 patients. The mean BMI was 46.4 kg/m(2). The initial mean anti-factor Xa level (measured after the third dose) was 0.34 IU/mL (range 0.20-0.59). Patients received an average of 18 doses. Two cases required an increase or decrease in dosage based on anti-factor Xa levels. Morbidity related to this dosing included a single event of minor endotracheal bleeding and a single deep vein thrombosis that was likely present prior to treatment. CONCLUSIONS: Weight-based dosing with enoxaparin in morbidly obese SICUpatients was effective in achieving anti-factor Xa levels within the appropriate prophylactic range. This regimen reduced the rate of VTE below expected levels and no additional adverse effects were reported.
Authors: Simon Gabriel Rodier; Marko Bukur; Samantha Moore; Spiros George Frangos; Manish Tandon; Charles Joseph DiMaggio; Patricia Ayoung-Chee; Gary Thomas Marshall Journal: Eur J Trauma Emerg Surg Date: 2019-08-30 Impact factor: 3.693
Authors: Alvina Mushtaq; Janelle D Vaughns; Victoria C Ziesenitz; Evan P Nadler; John N van den Anker Journal: Obes Surg Date: 2015-10 Impact factor: 4.129
Authors: Tzu-Fei Wang; Paul E Milligan; Catherine A Wong; Eli N Deal; Mark S Thoelke; Brian F Gage Journal: Thromb Haemost Date: 2013-10-17 Impact factor: 5.249
Authors: Funda Celik; Alwin D R Huitema; Jan H Hooijberg; Arnold W J M van de Laar; Dees P M Brandjes; Victor E A Gerdes Journal: Obes Surg Date: 2015-04 Impact factor: 4.129