Original Research
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction: In extremely obese patients, there is limited data on the preferred thromboprophylactic agent (heparin vs. enoxaparin).
Research Question or Hypothesis: How effective and safe is enoxaparin thromboprophylaxis compared to heparin in extremely obese patients?
Study Design: A single-center retrospective cohort study
Methods: Adults with BMI>50 kg/m2 who received inpatient heparin or enoxaparin thromboprophylaxis between 01/27/2018 and 04/30/2022 were studied. Propensity score matching (PSM) was used to match patients in the two groups based on BMI, Caprini Score for VTE, and Charlson Comorbidity Index. The primary endpoints were VTE, major bleeding, and critical site bleeding (intracranial, intra-spinal, intraocular, pericardial, and retroperitoneal). The secondary endpoints were clinically relevant non-major bleeding, defined as acute or sub-acute clinically overt bleeding that did not meet the criteria for major bleeding and led to a prolonged hospital stay, and minor bleeding, defined as acute clinically overt bleeding that did not meet any other criteria. The Fisher's exact test compared the study endpoints. Statistical significance was defined by a 0.05 two-sided p value. For statistical test comparisons, IBM SPSS Statistics version 26 was used, and for PSM, Addinsoft's XLSTAT.
Results:
93 patients (55 enoxaparin, 38 heparin) met the inclusion criteria. 38 (69%) enoxaparin patients were matched with the 38 eligible heparin patients using the PSM. Thromboprophylaxis median (Q1, Q3) duration was 4 (3, 7) days with both anticoagulants [p=0.478]. 35 heparin patients (92%) received 5,000units BID and three (8%) TID. The daily enoxaparin dose was 40mg in 24 patients (63%), 60mg in three (8%), 80mg in 10 (26%), and 120mg in one (3%). No VTE, major, critical site, or clinically relevant non-major bleeding occurred. One minor bleeding was reported with heparin 5,000unit BID.
Conclusion: This study found no safety or efficacy differences between heparin and enoxaparin thromboprophylaxis in extremely obese patients. To confirm these findings, larger prospective studies with uniform dosing and longer durations are warranted.
Presenting Author
Sulaiman A Al-Zubairy PharmD, MBA, BCPS, BCOP, SIDP, LSSGBJohns Hopkins Aramco Healthcare
Authors
Amal H Alanazi PharmD Candidate
Imam Abdulrahman Bin Faisal University
Shahad Albassam PharmD Candidate
Imam Abdulrahman Bin Faisal University
Hassan Alhamad PharmD
Ministry of Health, Eastern Health Cluster
Bader H Alharbi PharmD
Johns Hopkins Aramco Healthcare
Hawra Alsadah PharmD Candidate
Imam Abdulrahman Bin Faisal University