Evaluation of weight based enoxaparin dosing on anti-Xa concentrations in patients with obesity

被引:12
作者
van Oosterom, Nameer [1 ,2 ]
Winckel, Karl [1 ,2 ]
Barras, Michael [1 ,2 ]
机构
[1] Princess Alexandra Hosp, Brisbane, Qld, Australia
[2] Univ Queensland, Brisbane, Qld, Australia
关键词
Enoxaparin; Low-molecular weight heparin; Obesity; Morbid obesity; Anticoagulation; Anti-Xa; PHARMACOKINETICS; HEPARINS;
D O I
10.1007/s11239-019-01847-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Current treatment dose of enoxaparin is based on total body weight (TBW), however dosage in obesity remains unclear. "Dose capping" commonly occurs if TBW > 100 kg minimising bleeding risk. However, this may result in under-dosing and increasing embolisation risk. The primary objective evaluated efficacy of current dosing strategies in obese patients and determined if resultant anti-Xa concentrations (aXaC) were therapeutic. The secondary objective was to investigate if an uncapped 0.75-0.85 mg/kg (TBW) twice daily dose, advocated by previous authors, results in therapeutic aXaC (0.5-1.0 IU/ml). This retrospective study included 133 patients with a median TBW of 128 kg, producing 59% therapeutic, 15% sub-therapeutic and 26% supra-therapeutic aXaC. Approximately 60% of patients in each dose group (< 0.75, 0.75-0.85 and > 0.85 mg/kg) had a therapeutic aXaC, however the percentage of sub-therapeutic versus supra-therapeutic was higher in the < 0.75 (27% vs 9%) and > 0.85 mg/kg (10% vs 34%) groups respectively. Most patients who weighed 100-119 kg (TBW) received doses > 0.85 mg/kg, however 32% had toxic aXaC. Those between 120 and 139 kg (TBW) had a high percentage of therapeutic aXaC (87%) when dosed < 0.75 mg/kg and a high percentage of supra-therapeutic aXaC (71%) when dosed > 0.85 mg/kg; although numbers were low. Dose reduction occurred in patients > 140 kg (TBW), however < 0.75 mg/kg resulted in higher percentage of sub-therapeutic aXaC (42%). Dosing at 0.75-0.85 mg/kg results in 62% of therapeutic, 14% sub-therapeutic and 24% supra-therapeutic aXaC. This appears to be a "safe" starting dose-range, however all obese patients should have aXaC monitoring due to high inter-patient variability.
引用
收藏
页码:387 / 393
页数:7
相关论文
共 20 条
[1]   Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction - Results of the thrombolysis in myocardial infarction (TIMI) 11B trial [J].
Antman, EM ;
McCabe, CH ;
Gurfinkel, EP ;
Turpie, AGG ;
Bernink, PJLM ;
Salein, D ;
de Luna, AB ;
Fox, K ;
Lablanche, JM ;
Radley, D ;
Premmereur, J ;
Braunwald, E .
CIRCULATION, 1999, 100 (15) :1593-1601
[2]   Individualized Dosing of Enoxaparin for Subjects With Renal Impairment Is Superior to Conventional Dosing at Achieving Therapeutic Concentrations [J].
Barras, Michael A. ;
Duffull, Stephen B. ;
Atherton, John J. ;
Green, Bruce .
THERAPEUTIC DRUG MONITORING, 2010, 32 (04) :482-488
[3]   Current dosing of low-molecular-weight heparins does not reflect licensed product labels: an international survey [J].
Barras, Michael A. ;
Kirkpatrick, Carl M. J. ;
Green, Bruce .
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 2010, 69 (05) :520-528
[4]  
Chao BH, 2011, THROMBOSIS
[5]   A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease [J].
Cohen, M ;
Demers, C ;
Gurfinkel, EP ;
Turpie, AGG ;
Fromell, GJ ;
Goodman, S ;
Langer, A ;
Califf, RM ;
Fox, KAA ;
Premmereur, J ;
Bigonzi, F .
NEW ENGLAND JOURNAL OF MEDICINE, 1997, 337 (07) :447-452
[6]   Evaluation of therapeutic anticoagulation with enoxaparin and associated anti-Xa monitoring in patients with morbid obesity: a case series [J].
Deal, Eli N. ;
Hollands, James M. ;
Riney, Jennifer N. ;
Skrupky, Lee P. ;
Smith, Jennifer R. ;
Reichley, Richard M. .
JOURNAL OF THROMBOSIS AND THROMBOLYSIS, 2011, 32 (02) :188-194
[7]  
Department of Health, 2016, GUID ANT PROPH US LO
[8]   Development of a dosing strategy for enoxaparin in obese patients [J].
Green, B ;
Duffull, SB .
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 2003, 56 (01) :96-103
[9]   Dosing in obesity: A simple solution to a big problem [J].
Han, P. Y. ;
Duffull, S. B. ;
Kirkpatrick, C. M. J. ;
Green, B. .
CLINICAL PHARMACOLOGY & THERAPEUTICS, 2007, 82 (05) :505-508
[10]   Effect of Obesity on the Pharmacokinetics of Drugs in Humans [J].
Hanley, Michael J. ;
Abernethy, Darrell R. ;
Greenblatt, David J. .
CLINICAL PHARMACOKINETICS, 2010, 49 (02) :71-87