title: Dosing of enoxaparin for venous thromboembolism prophylaxis in obese patients.
abstract: OBJECTIVE
  To evaluate the appropriate dosing of enoxaparin as a venous thromboembolism (VTE) prophylaxis in hospitalized obese patients.
  
  
  METHODS
  Literature articles were accessed through MEDLINE (1946 to August week 1, 2013) and EMBASE (1980 to 2013 week 33) searches using the terms enoxaparin, obesity, and thromboprophylaxis.
  
  
  METHODS
  All articles that involved human subjects and were published in the English language, evaluating the appropriate dose of enoxaparin for VTE prophylaxis in hospitalized, obese patients were included.
  
  
  RESULTS
  Appropriate enoxaparin dosing for thromboprophylaxis in adult patients is 40 mg subcutaneously daily or 30 mg subcutaneously twice daily. Although obesity is considered one of the risk factors for thromboembolism, morbidly obese patients were excluded from most clinical trials; therefore, the appropriate enoxaparin preventive dose is not clear in this population. In recent years, the appropriate dose of enoxaparin for VTE prophylaxis in obese patients has been evaluated in 3 clinical studies. All studies enrolled patients with various risk factors for thromboembolism and evaluated different enoxaparin dosing regimens. End point analyses were all based on anti-Xa levels.
  
  
  CONCLUSIONS
  Due to a lack of well-designed prospective, randomized control studies, varying doses of enoxaparin are used for VTE prophylaxis in hospitalized, obese patients. All doses studied were monitored using anti-Xa levels. Patient follow-up was of short duration in all studies and did not show long-term effectiveness of enoxaparin. Prospective, randomized controlled studies are warranted to show efficacy and safety of one dosage regimen over another.
authors.affiliation: MCPHS University, School of Pharmacy-Worcester MA/Manchester NH, USA.
authors.forename: Kristine C
authors.initials: KC
authors.lastname: Willett
authors.forename: Mohammad
authors.initials: M
authors.lastname: Alsharhan
authors.forename: Cheryl
authors.initials: C
authors.lastname: Durand
authors.forename: Maryann R
authors.initials: MR
authors.lastname: Cooper
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D017984:Enoxaparin / Q000008:administration & dosage*; D006801:Humans; D009765:Obesity / Q000188:drug therapy*; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin
keywords: enoxaparin; obesity; thromboprophylaxis