Evaluation of therapeutic anticoagulation with enoxaparin and associated anti-Xa monitoring in patients with morbid obesity: a case series
| Autor: | Eli N. Deal, Lee P. Skrupky, Jennifer R. Smith, Jennifer N. Riney, Richard M. Reichley, James M. Hollands |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.drug_class Low molecular weight heparin Hemorrhage Morbid obesity chemistry.chemical_compound Fibrinolytic Agents Internal medicine Humans Medicine Enoxaparin Aged Monitoring Physiologic Retrospective Studies Creatinine Hematology Blood Coagulation Factor Inhibitors business.industry Retrospective cohort study Venous Thromboembolism Middle Aged medicine.disease Obesity Obesity Morbid Surgery Clinical trial chemistry Evaluation Studies as Topic Cohort Female Cardiology and Cardiovascular Medicine business Factor Xa Inhibitors |
| Zdroj: | Journal of Thrombosis and Thrombolysis. 32:188-194 |
| ISSN: | 1573-742X 0929-5305 |
| Popis: | Our purpose was to describe anti-Xa levels, dosage requirements, and complications associated with enoxaparin treatment doses in patients with morbid obesity. Inpatients with a BMI40 kg/m(2) at an academic medical center prescribed therapeutic enoxaparin from 2004 to 2010 who also had an associated anti-Xa level were included in this retrospective evaluation. Twenty-six patients were identified having median weight of 162 kg (range 106-243), median BMI of 49.5 kg/m(2) (range 40.1-98.1), and median enoxaparin duration of 4 days (range 1-32). Venous thromboembolism was the most common reason for anticoagulation (n = 19, 73%). The median starting dose was 0.8 mg/kg actual body weight (range 0.51-1; absolute dose 80-150 mg) every 12 h. Twelve patients (46%) achieved a goal anti-Xa level, 10 (38%) were above goal and 4 (15%) were uninterpretable. Among the 10 patients with anti-Xa levels above goal, the median initial dose was 0.85 mg/kg (range 0.75-1) versus 0.74 mg/kg (range 0.51-1) for patients at goal with similar median peak serum creatinine (PSCr) values between these two groups (P 0.05). No bleeding events occurred in patients achieving goal anticoagulation versus 4/10 (40%) with high anti-Xa levels (P = 0.033) with similar median PSCr between these groups. No thrombotic events occurred while on therapy. The majority in this cohort with morbid obesity achieved anti-Xa levels at or above goal at doses less than the recommended 1 mg/kg every 12 h. Bleeding events were more frequent among patients with anti-Xa levels above goal, despite similar PSCr values. |
| Databáze: | OpenAIRE |
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