title: A randomized controlled trial of differing doses of postcesarean enoxaparin thromboprophylaxis in obese women.
abstract: OBJECTIVE
  To compare two enoxaparin dosing strategies at achieving prophylactic anti-Xa levels in women with a body mass index (BMI) ⩾35 (kg m(-2)) postcesarean delivery.
  
  
  METHODS
  Women with BMI ⩾35 were randomized to receive prophylactic enoxaparin at a fixed dose of 40 mg daily or weight-based dosing of 0.5 mg kg(-1) twice daily. The primary outcome was the proportion of subjects with peak anti-Xa levels in the prophylactic range of 0.2 to 0.6 IU ml(-1).
  
  
  RESULTS
  From August 2013 through February 2014, 84 demographically similar women completed the protocol. In the weight-based group, 88% (37/42) of the women reached prophylactic anti-Xa levels versus 14% (6/42) in the fixed dose group (odds ratio 44.4, 95% confidence interval 12.44, 158.48, P<0.001). No anti-Xa level exceeded 0.48 IU ml(-1). There were no venous thromboembolic or bleeding events requiring reoperation or transfusion in either group.
  
  
  CONCLUSIONS
  Compared with fixed dosing daily, weight-based dosing twice daily more effectively achieved prophylactic anti-Xa levels without reaching the therapeutic range.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA.|Department of Obstetrics and Gynecology, Memorial Care Center for Women at Miller Children's Hospital, Long Beach Memorial Medical Center, Long Beach, CA, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Stephenson
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA.|Department of Obstetrics and Gynecology, Memorial Care Center for Women at Miller Children's Hospital, Long Beach Memorial Medical Center, Long Beach, CA, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Serra
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA.|Department of Obstetrics and Gynecology, Memorial Care Center for Women at Miller Children's Hospital, Long Beach Memorial Medical Center, Long Beach, CA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Neeper
authors.affiliation: Department of Obstetrics and Gynecology, Memorial Care Center for Women at Miller Children's Hospital, Long Beach Memorial Medical Center, Long Beach, CA, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Caballero
authors.affiliation: Department of Obstetrics and Gynecology, Memorial Care Center for Women at Miller Children's Hospital, Long Beach Memorial Medical Center, Long Beach, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: McNulty
mesh_terms: D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects*; D015992:Body Mass Index; D018890:Chemoprevention / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects; D015951:Factor Xa; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D009765:Obesity / Q000150:complications / Q000175:diagnosis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D017984:Enoxaparin; D065427:Factor Xa Inhibitors; D015951:Factor Xa