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Enoxaparin Dosing at Extremes of Weight: Literature Review and Dosing Recommendations

期刊

ANNALS OF PHARMACOTHERAPY
卷 52, 期 9, 页码 898-909

出版社

SAGE PUBLICATIONS INC
DOI: 10.1177/1060028018768449

关键词

low-molecular-weight heparins; obesity; prophylaxis; internal medicine; drug monitoring; dosing

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Objective: To review the literature on both thromboprophylaxis and treatment of venous thromboembolism (VTE) with enoxaparin in low- and high-body-weight patients and to make dosing and monitoring recommendations in these patient populations. Data Sources: A search using PubMed was conducted (1995 to January 2018) using the following key words: enoxaparin, body weight, AND thromboprophylaxis, or AND treatment. Additional references were identified from a review of citations. Study Selection and Data Extraction: Studies included examined the effect of body weight and/or body mass index (BMI) on VTE, bleeding, enoxaparin dosing, and/or anti-Xa concentrations for thromboprophylaxis and treatment-dose enoxaparin. Studies in pediatric and pregnant patients were excluded. Data Synthesis: Optimal enoxaparin dosing strategies for VTE prophylaxis and treatment for patients at extremes of weight have not yet been elucidated by clinical trials; however, data suggest that standard dosing regimens may not be appropriate in these patients. Relevance to Patient Care and Clinical Practice: This review provides a thorough discussion on both thromboprophylaxis and treatment of VTE with enoxaparin in low- and high-body-weight patients. It includes dosing recommendations to guide clinicians caring for these patient populations. Conclusions: Patients at extremes of weight require special consideration to determine appropriate enoxaparin doses. Specifically, low-body-weight patients may benefit from 30 mg subcutaneously daily for VTE prophylaxis, and standard weight-based dosing for VTE treatment. Conversely, in patients with BMIs >= 40 kg/m(2), 40 mg subcutaneously twice daily is recommended, with consideration for higher doses in patients with BMIs >= 50 kg/m(2).

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