Weight-Based Dosing for Once-Daily Enoxaparin Cannot Provide Adequate Anticoagulation for Venous Thromboembolism Prophylaxis
Surgeons commonly provide enoxaparin prophylaxis to high-risk patients to decrease venous thromboembolism risk. The authors' prior work demonstrated that most patients receive inadequate venous thromboembolism prophylaxis, based on anti-factor Xa level, when enoxaparin 40 mg/day is provided and...
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| Veröffentlicht in: | Plastic and reconstructive surgery (1963) 2017-10, Vol.140 (4), p.815-822 |
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| creator | Pannucci, Christopher J. Hunt, Madison M. Fleming, Kory I. Prazak, Ann Marie |
| description | Surgeons commonly provide enoxaparin prophylaxis to high-risk patients to decrease venous thromboembolism risk. The authors' prior work demonstrated that most patients receive inadequate venous thromboembolism prophylaxis, based on anti-factor Xa level, when enoxaparin 40 mg/day is provided and that peak anti-factor Xa level correlates with weight. This study models a weight-based strategy for daily enoxaparin prophylaxis and its impact on anti-factor Xa levels.
The authors enrolled plastic surgery patients who received enoxaparin 40 mg/day and had anti-factor Xa levels drawn. The enoxaparin dose of 40 mg was converted to a milligram-per-kilogram dose for each patient. Stratified analysis examined the milligram-per-kilogram dose that produced low, in-range, and high anti-factor Xa levels to identify the appropriate milligram-per-kilogram dose to optimize venous thromboembolism prevention and bleeding events.
Among 94 patients, weight-based dosing ranged from 0.28 to 0.94 mg/kg once daily. For peak and trough anti-factor Xa levels, there was nearly complete overlap for milligram-per-kilogram dosing that produced low versus in-range anti-factor Xa levels. For peak anti-factor Xa, there was nearly complete overlap for milligram-per-kilogram dosing that produced in-range versus high anti-factor Xa levels. Mean milligram-per-kilogram dose was not significantly different between patients who did or did not have postoperative venous thromboembolism (0.41 mg/kg versus 0.52 mg/kg; p = 0.085) or clinically relevant bleeding (0.48 mg/kg versus 0.51 mg/kg; p = 0.73).
Alterations in enoxaparin dose magnitude based on patient weight cannot allow a high proportion of patients to achieve appropriate anti-factor Xa levels when once-daily enoxaparin prophylaxis is provided. Future research should examine the impact of increased enoxaparin dose frequency on anti-factor Xa levels, venous thromboembolism events, and bleeding.
Therapeutic, IV. |
| doi_str_mv | 10.1097/PRS.0000000000003692 |
| format | Article |
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The authors enrolled plastic surgery patients who received enoxaparin 40 mg/day and had anti-factor Xa levels drawn. The enoxaparin dose of 40 mg was converted to a milligram-per-kilogram dose for each patient. Stratified analysis examined the milligram-per-kilogram dose that produced low, in-range, and high anti-factor Xa levels to identify the appropriate milligram-per-kilogram dose to optimize venous thromboembolism prevention and bleeding events.
Among 94 patients, weight-based dosing ranged from 0.28 to 0.94 mg/kg once daily. For peak and trough anti-factor Xa levels, there was nearly complete overlap for milligram-per-kilogram dosing that produced low versus in-range anti-factor Xa levels. For peak anti-factor Xa, there was nearly complete overlap for milligram-per-kilogram dosing that produced in-range versus high anti-factor Xa levels. Mean milligram-per-kilogram dose was not significantly different between patients who did or did not have postoperative venous thromboembolism (0.41 mg/kg versus 0.52 mg/kg; p = 0.085) or clinically relevant bleeding (0.48 mg/kg versus 0.51 mg/kg; p = 0.73).
Alterations in enoxaparin dose magnitude based on patient weight cannot allow a high proportion of patients to achieve appropriate anti-factor Xa levels when once-daily enoxaparin prophylaxis is provided. Future research should examine the impact of increased enoxaparin dose frequency on anti-factor Xa levels, venous thromboembolism events, and bleeding.
Therapeutic, IV.</description><identifier>ISSN: 0032-1052</identifier><identifier>EISSN: 1529-4242</identifier><identifier>DOI: 10.1097/PRS.0000000000003692</identifier><identifier>PMID: 28953735</identifier><language>eng</language><publisher>United States: by the American Society of Plastic Surgeons</publisher><subject>Adult ; Aged ; Anticoagulants - administration & dosage ; Blood Coagulation - drug effects ; Body Weight ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Enoxaparin - administration & dosage ; Female ; Follow-Up Studies ; Humans ; Injections, Subcutaneous ; Male ; Middle Aged ; Postoperative Complications - blood ; Postoperative Complications - prevention & control ; Prospective Studies ; Reconstructive Surgical Procedures - adverse effects ; Time Factors ; Treatment Outcome ; Venous Thromboembolism - blood ; Venous Thromboembolism - etiology ; Venous Thromboembolism - prevention & control</subject><ispartof>Plastic and reconstructive surgery (1963), 2017-10, Vol.140 (4), p.815-822</ispartof><rights>by the American Society of Plastic Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3523-1b908d7a0d645bc42b29abf33eaa05fac6f10b4f50b2f6cdd56aa71d1cc14d233</citedby><cites>FETCH-LOGICAL-c3523-1b908d7a0d645bc42b29abf33eaa05fac6f10b4f50b2f6cdd56aa71d1cc14d233</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28953735$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pannucci, Christopher J.</creatorcontrib><creatorcontrib>Hunt, Madison M.</creatorcontrib><creatorcontrib>Fleming, Kory I.</creatorcontrib><creatorcontrib>Prazak, Ann Marie</creatorcontrib><title>Weight-Based Dosing for Once-Daily Enoxaparin Cannot Provide Adequate Anticoagulation for Venous Thromboembolism Prophylaxis</title><title>Plastic and reconstructive surgery (1963)</title><addtitle>Plast Reconstr Surg</addtitle><description>Surgeons commonly provide enoxaparin prophylaxis to high-risk patients to decrease venous thromboembolism risk. The authors' prior work demonstrated that most patients receive inadequate venous thromboembolism prophylaxis, based on anti-factor Xa level, when enoxaparin 40 mg/day is provided and that peak anti-factor Xa level correlates with weight. This study models a weight-based strategy for daily enoxaparin prophylaxis and its impact on anti-factor Xa levels.
The authors enrolled plastic surgery patients who received enoxaparin 40 mg/day and had anti-factor Xa levels drawn. The enoxaparin dose of 40 mg was converted to a milligram-per-kilogram dose for each patient. Stratified analysis examined the milligram-per-kilogram dose that produced low, in-range, and high anti-factor Xa levels to identify the appropriate milligram-per-kilogram dose to optimize venous thromboembolism prevention and bleeding events.
Among 94 patients, weight-based dosing ranged from 0.28 to 0.94 mg/kg once daily. For peak and trough anti-factor Xa levels, there was nearly complete overlap for milligram-per-kilogram dosing that produced low versus in-range anti-factor Xa levels. For peak anti-factor Xa, there was nearly complete overlap for milligram-per-kilogram dosing that produced in-range versus high anti-factor Xa levels. Mean milligram-per-kilogram dose was not significantly different between patients who did or did not have postoperative venous thromboembolism (0.41 mg/kg versus 0.52 mg/kg; p = 0.085) or clinically relevant bleeding (0.48 mg/kg versus 0.51 mg/kg; p = 0.73).
Alterations in enoxaparin dose magnitude based on patient weight cannot allow a high proportion of patients to achieve appropriate anti-factor Xa levels when once-daily enoxaparin prophylaxis is provided. Future research should examine the impact of increased enoxaparin dose frequency on anti-factor Xa levels, venous thromboembolism events, and bleeding.
Therapeutic, IV.</description><subject>Adult</subject><subject>Aged</subject><subject>Anticoagulants - administration & dosage</subject><subject>Blood Coagulation - drug effects</subject><subject>Body Weight</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug Administration Schedule</subject><subject>Enoxaparin - administration & dosage</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Injections, Subcutaneous</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Postoperative Complications - blood</subject><subject>Postoperative Complications - prevention & control</subject><subject>Prospective Studies</subject><subject>Reconstructive Surgical Procedures - adverse effects</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Venous Thromboembolism - blood</subject><subject>Venous Thromboembolism - etiology</subject><subject>Venous Thromboembolism - prevention & control</subject><issn>0032-1052</issn><issn>1529-4242</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkGtLwzAUhoMoOqf_QKR_IDOXpl0_6pwXECZeP5bTJF2jXTKT1jnwx9s5b3jgcC7wPh8ehA4oGVCSpUfXN7cD8qd4krEN1KOCZThmMdtEve7JMCWC7aDdEJ4IoSlPxDbaYcNM8JSLHnp_1GZaNfgEglbRqQvGTqPS-WhipcanYOplNLbuDebgjY1GYK1romvvXo3S0bHSLy003WIbIx1M2xoa4-wn4UFb14borvJuVjjddW3CbJWdV8sa3kzYQ1sl1EHvf80-uj8b340u8NXk_HJ0fIUlF4xjWmRkqFIgKolFIWNWsAyKknMNQEQJMikpKeJSkIKViVRKJAApVVRKGivGeR_Fa670LgSvy3zuzQz8MqckX8nMO5n5f5ld7HAdm7fFTKuf0Le9X-7C1Y324bluF9rnlYa6qT55ieAxZp13urrwisz5B5PUgkw</recordid><startdate>20171001</startdate><enddate>20171001</enddate><creator>Pannucci, Christopher J.</creator><creator>Hunt, Madison M.</creator><creator>Fleming, Kory I.</creator><creator>Prazak, Ann Marie</creator><general>by the American Society of Plastic Surgeons</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20171001</creationdate><title>Weight-Based Dosing for Once-Daily Enoxaparin Cannot Provide Adequate Anticoagulation for Venous Thromboembolism Prophylaxis</title><author>Pannucci, Christopher J. ; Hunt, Madison M. ; Fleming, Kory I. ; Prazak, Ann Marie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3523-1b908d7a0d645bc42b29abf33eaa05fac6f10b4f50b2f6cdd56aa71d1cc14d233</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anticoagulants - administration & dosage</topic><topic>Blood Coagulation - drug effects</topic><topic>Body Weight</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug Administration Schedule</topic><topic>Enoxaparin - administration & dosage</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Injections, Subcutaneous</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Postoperative Complications - blood</topic><topic>Postoperative Complications - prevention & control</topic><topic>Prospective Studies</topic><topic>Reconstructive Surgical Procedures - adverse effects</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Venous Thromboembolism - blood</topic><topic>Venous Thromboembolism - etiology</topic><topic>Venous Thromboembolism - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pannucci, Christopher J.</creatorcontrib><creatorcontrib>Hunt, Madison M.</creatorcontrib><creatorcontrib>Fleming, Kory I.</creatorcontrib><creatorcontrib>Prazak, Ann Marie</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Plastic and reconstructive surgery (1963)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pannucci, Christopher J.</au><au>Hunt, Madison M.</au><au>Fleming, Kory I.</au><au>Prazak, Ann Marie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Weight-Based Dosing for Once-Daily Enoxaparin Cannot Provide Adequate Anticoagulation for Venous Thromboembolism Prophylaxis</atitle><jtitle>Plastic and reconstructive surgery (1963)</jtitle><addtitle>Plast Reconstr Surg</addtitle><date>2017-10-01</date><risdate>2017</risdate><volume>140</volume><issue>4</issue><spage>815</spage><epage>822</epage><pages>815-822</pages><issn>0032-1052</issn><eissn>1529-4242</eissn><abstract>Surgeons commonly provide enoxaparin prophylaxis to high-risk patients to decrease venous thromboembolism risk. The authors' prior work demonstrated that most patients receive inadequate venous thromboembolism prophylaxis, based on anti-factor Xa level, when enoxaparin 40 mg/day is provided and that peak anti-factor Xa level correlates with weight. This study models a weight-based strategy for daily enoxaparin prophylaxis and its impact on anti-factor Xa levels.
The authors enrolled plastic surgery patients who received enoxaparin 40 mg/day and had anti-factor Xa levels drawn. The enoxaparin dose of 40 mg was converted to a milligram-per-kilogram dose for each patient. Stratified analysis examined the milligram-per-kilogram dose that produced low, in-range, and high anti-factor Xa levels to identify the appropriate milligram-per-kilogram dose to optimize venous thromboembolism prevention and bleeding events.
Among 94 patients, weight-based dosing ranged from 0.28 to 0.94 mg/kg once daily. For peak and trough anti-factor Xa levels, there was nearly complete overlap for milligram-per-kilogram dosing that produced low versus in-range anti-factor Xa levels. For peak anti-factor Xa, there was nearly complete overlap for milligram-per-kilogram dosing that produced in-range versus high anti-factor Xa levels. Mean milligram-per-kilogram dose was not significantly different between patients who did or did not have postoperative venous thromboembolism (0.41 mg/kg versus 0.52 mg/kg; p = 0.085) or clinically relevant bleeding (0.48 mg/kg versus 0.51 mg/kg; p = 0.73).
Alterations in enoxaparin dose magnitude based on patient weight cannot allow a high proportion of patients to achieve appropriate anti-factor Xa levels when once-daily enoxaparin prophylaxis is provided. Future research should examine the impact of increased enoxaparin dose frequency on anti-factor Xa levels, venous thromboembolism events, and bleeding.
Therapeutic, IV.</abstract><cop>United States</cop><pub>by the American Society of Plastic Surgeons</pub><pmid>28953735</pmid><doi>10.1097/PRS.0000000000003692</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Plastic and reconstructive surgery (1963), 2017-10, Vol.140 (4), p.815-822 |
| issn | 0032-1052 1529-4242 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Aged Anticoagulants - administration & dosage Blood Coagulation - drug effects Body Weight Dose-Response Relationship, Drug Drug Administration Schedule Enoxaparin - administration & dosage Female Follow-Up Studies Humans Injections, Subcutaneous Male Middle Aged Postoperative Complications - blood Postoperative Complications - prevention & control Prospective Studies Reconstructive Surgical Procedures - adverse effects Time Factors Treatment Outcome Venous Thromboembolism - blood Venous Thromboembolism - etiology Venous Thromboembolism - prevention & control |
| title | Weight-Based Dosing for Once-Daily Enoxaparin Cannot Provide Adequate Anticoagulation for Venous Thromboembolism Prophylaxis |
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