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. 2018 May 18:10:63-70.
doi: 10.2147/CPAA.S161599. eCollection 2018.

Anti-factor Xa levels in obese patients receiving enoxaparin for treatment and prophylaxis indications

Linda Tahaineh  1 , Sahar M Edaily  1 , Shadi F Gharaibeh  2
Affiliations

Anti-factor Xa levels in obese patients receiving enoxaparin for treatment and prophylaxis indications

Linda Tahaineh et al. Clin Pharmacol. .

Abstract

Objectives: To evaluate the degree of anticoagulation achieved with different enoxaparin dosing regimens used in obese and morbidly obese patients in a hospital setting in Jordan.

Methods: All obese adult patients who were prescribed enoxaparin for various indications were invited to participate in the study. The anti-factor Xa (anti-Xa) level was checked once after 4-6 hours of the third or fourth dose of enoxaparin (at steady state). Patients were followed daily to evaluate drug efficacy and safety through their hospital course.

Results: Enoxaparin daily dose used for prophylaxis indications ranged from 0.3 to 0.85 mg/kg and from 0.31 to 2.25 mg/kg in case of certain treatment indications. Most participants who received enoxaparin for treatment indications (76.9%) were on capping dosing regimens, which was <1 mg/kg twice daily. On the other hand, most patients (88.5%) who received enoxaparin for prophylaxis indications were on a fixed 40 mg/d dose. Among the 52 patients who completed the study, 19 patients (36.5%) had therapeutic anti-Xa levels. The results showed no statistically significant associations between regimens that were used and achieving therapeutic anti-Xa level (p>0.05). No bleeding events or thrombocytopenia were noticed, and there was one case of recurrent thrombosis.

Conclusion: Enoxaparin dosing regimens that were used for obese patients varied based on prescribing physicians. Regardless of the regimen used, the majority of participants had nontherapeutic anti-Xa. Individualized dosing regimens based on anti-Xa levels are warranted for obese patients on enoxaparin.

Keywords: anti-factor Xa; anticoagulation; enoxaparin; obesity.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram for this study population. Abbreviation: KAUH, King Abdullah University Hospital.
Figure 2
Figure 2
Anti-Xa levels for patients receiving different treatment and prophylaxis daily doses of enoxaparin. Abbreviation: Anti-Xa, anti-factor Xa.
Figure 3
Figure 3
Anti-Xa levels for females and males receiving different prophylaxis daily doses of enoxaparin. Abbreviation: Anti-Xa, anti-factor Xa.
See this image and copyright information in PMC

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