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. 2025 Mar;59(3):262-276.
doi: 10.1177/10600280241256351. Epub 2024 Jun 19.

Therapeutic Enoxaparin Dosing in Obesity

Marcelle Appay  1   2 , Shreyas Kharadi  1 , Sajani Nanayakkara  1 , Ji Sang Ryu  1 , Leonardo Pasalic  3   4   5 , Jan-Willem Alffenaar  1   6
Affiliations

Therapeutic Enoxaparin Dosing in Obesity

Marcelle Appay et al. Ann Pharmacother. 2025 Mar.

Abstract

Objective: This review aims to systematically summarize the available data on efficacy and safety of therapeutic enoxaparin in obese patients and to identify gaps to guide future research.

Data sources: Medline and Embase were systematically searched for eligible studies (last searched December 20, 2023). Studies were included if they reported on therapeutic dosing regimens, adverse bleeding, thrombotic outcomes, or antifactor Xa (AFXa) monitoring in obese adult patients.

Study selection and data extraction: The systematic review management tool Covidence was used to manage the study selection and data extraction process. The reference list from eligible studies was screened to determine any additional eligible studies.

Data synthesis: Sixteen studies were included in the analysis. Studies used a variety of doses, indications, and study designs making comparison difficult. Twelve studies reported the incidence of thrombotic events (median = 1.3% [interquartile range [IQR] = 0.3%-2.3%]) and all studies reported the incidence of bleeding events (median = 5.7% [IQR = 2.4%-14.5%]). Two of the 8 studies analyzing the influence of weight/body mass index (BMI) or dose per kg on AFXa levels reported statistically significant results. One study concluded that BMI did not affect achievement of target AFXa levels. However, the second study found that dosing using actual body weight was an independent predictor of supratherapeutic AFXa levels in the obese population.

Relevance to patient care and clinical practice: This is the first comprehensive review with a focus on therapeutic dosing of enoxaparin in obesity and has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Seven of the included studies were published since 2018 indicating that new evidence on this topic is emerging.

Conclusion: There was inadequate evidence to support an optimal dosing strategy in obese patients due to the heterogeneity of the studies. The AFXa monitoring may be appropriate to guide dosing in this population. Further research is required to determine a suitable dosing regimen.

Keywords: AFXa levels; Antifactor Xa levels; LMWH; enoxaparin; low molecular weight heparin; obesity; treatment.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of the Inclusion Criteria.
See this image and copyright information in PMC

References

    1. Wendelboe A, Raskob G. Global burden of thrombosis: epidemiologic aspects. Circ Res. 2016;118(9):1340-1347. doi: 10.1161/CIRCRESAHA.115.306841 - DOI - PubMed
    1. Vos T, Lim S, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-1222. doi: 10.1016/S0140-6736(20)30925-9 - DOI - PMC - PubMed
    1. Heit J. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015;12(8):464-474. doi: 10.1038/nrcardio.2015.83 - DOI - PMC - PubMed
    1. Raskob GE, Angchaisuksiri P, Blanco AN, et al. Thrombosis: a major contributor to the global disease burden. J Throm Haemost. 2014;12(10):1580-1590. doi: 10.1111/jth.12698 - DOI - PubMed
    1. Tan BK, Mainbourg S, Friggeri A, et al. Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis. Thorax. 2021;76(10):970-979. doi: 10.1136/thoraxjnl-2020-215383 - DOI - PubMed

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