Scientific Poster Session II - Original Research

Original Research
  Sunday, October 13, 2024
  12:45 PM–02:15 PM

Abstract

Introduction: Standard enoxaparin venous thromboembolism (VTE) treatment dosing is 1 mg/kg twice daily; however, recent literature suggests a modified dose in obese patients. In 2020, modified enoxaparin VTE treatment dosing strategy of 0.75 mg/kg was implemented in hospitalized obese patients based on an internal review of a small outpatient cohort.

Research Question or Hypothesis: To evaluate the safety and efficacy of a modified enoxaparin dosing protocol in hospitalized patients with a BMI = 40 kg/m².

Study Design: A retrospective, multicenter cohort study utilized the electronic health record to identify adult patients with BMI = 40 kg/m² admitted to a 10-hospital health system from May 2020 through September 2023 receiving VTE treatment with enoxaparin and obtained a low molecular weight heparin (LMWH)-calibrated anti-Xa peak level at steady state.

Methods: The primary endpoint was percentage of LMWH anti-Xa peak levels within therapeutic range. Secondary endpoints include recurrence in thrombosis within 90 days of enoxaparin initiation and bleeding prevalence, including minor bleeding and major bleeding while on enoxaparin.

Results: Seventy-six patients met inclusion criteria. Thirty-eight followed the modified dosing protocol (0.65-0.85 mg/kg) and thirty-eight received traditional dosing >0.85 mg/kg. In the modified group, 21 (55%) LMWH-anti-Xa levels were therapeutic versus 15 (39%) in the traditional dose (p<0.001). The average LMWH-anti-Xa level in the modified group was 0.90 IU/mL, versus 1.16 IU/mL in the traditional group (p=0.022). Minor bleeding occurred in 14 (34%) patients receiving modified doses and 15 patients (38%) receiving traditional doses (OR 0.97, 95% CI 0.39-2.46). Major bleeding occurred in four patients (11%) in the traditional group (p>0.05). Recurrent thrombosis occurred in two (5%) traditional group patients (>0.05).

Conclusion: A modified enoxaparin dosing scheme resulted in a higher proportion of patients obtaining therapeutic levels; however, no major differences were noted in thrombosis and bleeding endpoints. Adherence to the modified dosing protocol is poor. Future prospective studies are needed to validate results.

Presenting Author

Brooke Pederson PharmD
M Health Fairview

Authors

Jennifer Osborn PharmD, BCCP, BCPS
M Health Fairview - University of Minnesota Medical Center