How is weight based enoxaparin dosed in an obese patient?

How does obesity affect enoxaparin?

In the analysis of SQ enoxaparin, it was found that obese patients took longer to reach steady state concentrations when compared to normal weight individuals and obese patients also had higher exposure in terms of anti-Xa activity (14% higher on day 1, P = 0.006; 19% higher on day 4, P = 0.001).

Is Lovenox dosed by actual body weight?

The LMWH agent enoxaparin (Lovenox) has no official dosing recommendations for these patients,3 but data in this population suggest that a reduced weight-based dose (less than 1 mg per kg) is warranted.

Is LMWH preferred in obese patients?

Conclusion: Obese patients, weighing 90-150 kg, receiving LMWH for bridge therapy should receive dosages based on total body weight. Unfractionated heparin is recommended in patients weighing more than 150 kg; however, if LMWH is used, antifactor Xa levels should be monitored.

Is enoxaparin weight-based?

This is unexpected, as the existing standard of care for therapeutic anticoagulation (e.g., in patients with established venous thromboembolism) is weight-based—enoxaparin is typically provided at 1 mg/kg twice daily or 1.5 mg/kg once daily.

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What anticoagulant is used for obese patients?

As regards NOAC, rivaroxaban, apixaban, or dabigatran may be used as thromboprophylaxis in patients with BMI < 40 kg/m2 (n = 4 studies), whereas rivaroxaban and apixaban may be administered to obese patients with VTE or AF, including BMI > 40 kg/m2, at standard fixed-dose (n = 20 studies).

Which is the anticoagulant of choice for morbidly obese patients?

In patients with a BMI of 40-50 kg/m2, warfarin should be used, but apixaban or edoxaban can be considered. In obese patients with a BMI > 50 kg/m2, warfarin should be used.

Does Lovenox affect INR?

Conclusion: This is the first clinical evidence of the effect of enoxaparin on INR in patients undergoing abdominal surgeries for malignancies. We demonstrate an increase in the INR for patients who received enoxaparin for post-operative VTE prophylaxis.

What weight should I use for enoxaparin?

Once-daily dosing regimens of enoxaparin are not recommended. BMI 30 to 39 kg/m2: Use standard prophylaxis dosing (ie, 30 mg every 12 hours or 40 mg once daily). Some experts use weight-based dosing (ie, 0.5 mg/kg based on TBW once or twice daily, depending upon level of VTE risk).

How do you calculate actual body weight?

A common formula is as follows:

  1. Men: IBW (kgs) = 22 × (height in meters)2.
  2. Women: IBW (kgs) = 22 × (height in meters − 10 cm)2.

Can apixaban be used in obese patients?

Among obese patients, apixaban was associated with a significantly lower risk of recurrent VTE (HR: 0.73; 95% CI: 0.64–0.84), MB (HR: 0.73; 95% CI: 0.62–0.85), and CRNM bleeding (HR: 0.82; 95% CI: 0.77–0.88) compared to warfarin (Figure 3).

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Can DOACs be used in obese patients?

However, despite the clear advantages, DOACs are not often used in morbidly obese patients. The International Society of Thrombosis and Haemostasis (ISTH) recommends against DOAC use in patients with a body mass index (BMI)≥40 kg·m2 or weight>120 kg because of the lack of available safety and efficacy data.

Is there a weight limit for eliquis?

What Is New? Apixaban is efficacious and safe across the spectrum of weight, including in low- (≤60 kg) and high-weight patients (>120 kg).

What is the dosing of enoxaparin?

40 mg subcutaneously once a day for 7 to 10 days‡ followed by 40 mg subcutaneously once a day for 3 weeks. Initial dose 9 to 15 hours before surgery. Acute DVT with or without PE, inpatient treatment 1 mg per kg subcutaneously every 12 hours (with warfarin).

How is Lovenox dosed?

Usual dose is a single intravenous bolus of 30 mg plus a 1 mg/kg subcutaneous dose followed by 1 mg/kg subcutaneously every 12 hours (max 100 mg for the first two doses), with aspirin. The usual duration of Lovenox treatment duration therapy is 8 days or until hospital discharge.

How is heparin dosed?

It is standard practice to give heparin, commencing with either an IV bolus of 10 000 U with repeated smaller bolus injections as required or as a weight-adjusted-dose regimen of 100 to 175 U/kg followed by 10 to 15 U/kg per hour.