title: Assessing an enoxaparin dosing protocol in morbidly obese patients.
abstract: The effect of obesity on the pharmacokinetics of enoxaparin is not clearly understood and traditional treatment doses in morbidly obese patients (body mass index [BMI] > 40 kg/m(2)) can lead to over anticoagulation. Our institution developed an inpatient protocol with reduced enoxaparin doses (0.75 mg/kg/dose based on actual body weight) for patients with a weight >200 kg or BMI > 40 kg/m(2). The primary objective was to determine if modified enoxaparin treatment doses would achieve therapeutic anti-Xa levels (goal range 0.6-1.0 IU/mL) in morbidly obese patients. Thirty-one patients were included in our study and had a median body weight of 138 kg (range 105-197) and a median BMI of 46.2 kg/m(2) (range 40.1-62). The initial peak anti-Xa levels were in therapeutic range in 15 of 31 patients (48 %) with an initial mean anti-Xa level of 0.92 IU/mL. Twenty-four patients (77 %) achieved therapeutic anti-Xa levels in goal range during their hospitalization, with a mean enoxaparin dose of 0.71 mg/kg. Bleeding and thrombotic events were minimal and all patients that achieved an anti-Xa level in goal range did so with a dose less than 1 mg/kg of enoxaparin.
authors.affiliation: Regis University School of Pharmacy, 3333 Regis Blvd H-28, Denver, CO, 80221-1099, USA, jlalama@regis.edu.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Lalama
authors.forename: Megan E
authors.initials: ME
authors.lastname: Feeney
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Vandiver
authors.forename: K Diane
authors.initials: KD
authors.lastname: Beavers
authors.forename: Leah N
authors.initials: LN
authors.lastname: Walter
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: McClintic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D017984:Enoxaparin / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D065427:Factor Xa Inhibitors / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000188:drug therapy; D012189:Retrospective Studies
chemical_list: D017984:Enoxaparin; D065427:Factor Xa Inhibitors
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