Systematic Reviews/Meta-Analysis
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Background: Data are variable regarding ideal weight-based dosing of therapeutic enoxaparin in class III obesity. This systematic review compared weight-based dosing categories in obese patients to determine likelihood of goal anti-Xa level achievement.
Methods: A systematic review of English language studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Articles were identified via Pubmed and EMBASE searches. Included studies reported therapeutic enoxaparin use in adult patients with a body mass index of at least 40 kg/m2 or body weight greater than 100 kg and the percentage of patients achieving a therapeutic anti-Xa based on a weight-based dose. Therapeutic attainment of anti-Xa levels were assessed across enoxaparin weight-based dosing categories including a significantly reduced dose group: < 0.75 mg/kg, reduced dose group: 0.75-0.85 mg/kg, and standard dose group: > 0.95 mg/kg. Rates of bleeding and thrombosis were also evaluated. Results were described descriptively due to study heterogeneity.
Results: Eight studies were included, seven retrospective and one prospective. For anti-Xa level assessment, 518 patients were included. In the significantly reduced dose group, 62% of anti-Xa levels were therapeutic, 66% in the reduced group, and 43% in the standard dose group. The rates of bleeding and thrombosis were assessed in 798 patients. Twenty-nine bleeds (3.6%) occurred. A majority of the bleeds (85.2%) occurred in patients receiving standard weight-based dosing (> 0.95 mg/kg). Thrombosis occurred in 5 patients (0.6%).
Discussion: This evidence demonstrates the potential for improved achievement of anti-Xa levels with reduced weight-based dosing of enoxaparin, but it is important to note that most data is drawn from retrospective studies. However, based on this data it is reasonable to use a reduced dose of enoxaparin in obese patients requiring therapeutic anticoagulation.
Other: No conflicts of interest or funding.
Presenting Author
Maya Chilbert Pharm.D., BCCPUniversity at Buffalo School of Pharmacy and Pharmaceutical Sciences
Authors
Uzma Ahmed PharmD, BCCCP
Mount Sinai Brooklyn
Amanda Devlin PharmD, BCCCP
Mount Sinai Beth Israel
Ashley Woodruff Pharm.D., BCPS
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Kimberly Zammit PharmD, BCPS, BCCP, FASHP
Mount Sinai
Sara Radparvar PharmD, BCPS, BCCCP
Mount Sinai
Ashley Schuler PharmD
Denver Health Medical Center