Effect of fondaparinux prophylaxis on anti-factor Xa concentrations in patients with morbid obesity
Anti-factor Xa values in morbidly obese patients receiving standard doses of fondaparinux sodium for the prevention of venous thromboembolism (VTE) were analyzed in a retrospective chart evaluation. The administration of low-molecular-weight heparins to obese patients (body mass index [BMI] of ≥30 k...
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| Veröffentlicht in: | American journal of health-system pharmacy 2011-09, Vol.68 (18), p.1716-1722 |
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| creator | Martinez, Larissa Burnett, Allison Borrego, Matthew Streeter, Jessica C Townsend, Kelly Garcia, David |
| description | Anti-factor Xa values in morbidly obese patients receiving standard doses of fondaparinux sodium for the prevention of venous thromboembolism (VTE) were analyzed in a retrospective chart evaluation.
The administration of low-molecular-weight heparins to obese patients (body mass index [BMI] of ≥30 kg/m(2)) at the dose recommended for VTE prophylaxis has been reported to result in increased thromboembolic events and decreased anti-factor Xa levels, and some evidence indicates that weight-based dosing adjustments may be appropriate. To study this phenomenon among morbidly obese patients (BMI of ≥40 kg/m(2)), a review of the charts of 45 adult patients for whom steady-state anti-factor Xa laboratory values were obtained after at least four fondaparinux injections was conducted; in all instances, fondaparinux sodium was given at the standard dose (2.5 mg once daily). Of the total of 47 anti-factor Xa values analyzed, 22 (47%) were below the study institution's target peak range (0.3-0.5 mg/L), 20 values (43%) were within the range, and 5 (11%) were above the range. No documented thromboembolic events occurred during hospitalization in the cases evaluated. A stepwise linear regression analysis of selected demographic and clinical variables indicated that better renal function, male sex, increased BMI, and fewer fondaparinux doses were associated with a greater likelihood of diminished anti-factor Xa activity in the cases evaluated.
Anti-factor Xa concentrations in morbidly obese patients receiving fondaparinux sodium 2.5 mg subcutaneously daily for VTE prophylaxis were within or above the target range in 53% of the instances evaluated. |
| doi_str_mv | 10.2146/ajhp110010 |
| format | Article |
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The administration of low-molecular-weight heparins to obese patients (body mass index [BMI] of ≥30 kg/m(2)) at the dose recommended for VTE prophylaxis has been reported to result in increased thromboembolic events and decreased anti-factor Xa levels, and some evidence indicates that weight-based dosing adjustments may be appropriate. To study this phenomenon among morbidly obese patients (BMI of ≥40 kg/m(2)), a review of the charts of 45 adult patients for whom steady-state anti-factor Xa laboratory values were obtained after at least four fondaparinux injections was conducted; in all instances, fondaparinux sodium was given at the standard dose (2.5 mg once daily). Of the total of 47 anti-factor Xa values analyzed, 22 (47%) were below the study institution's target peak range (0.3-0.5 mg/L), 20 values (43%) were within the range, and 5 (11%) were above the range. No documented thromboembolic events occurred during hospitalization in the cases evaluated. A stepwise linear regression analysis of selected demographic and clinical variables indicated that better renal function, male sex, increased BMI, and fewer fondaparinux doses were associated with a greater likelihood of diminished anti-factor Xa activity in the cases evaluated.
Anti-factor Xa concentrations in morbidly obese patients receiving fondaparinux sodium 2.5 mg subcutaneously daily for VTE prophylaxis were within or above the target range in 53% of the instances evaluated.</description><identifier>ISSN: 1079-2082</identifier><identifier>EISSN: 1535-2900</identifier><identifier>DOI: 10.2146/ajhp110010</identifier><identifier>PMID: 21880887</identifier><language>eng</language><publisher>England: American Society of Health-System Pharmacists</publisher><subject>Adult ; Aged ; Anticoagulants - pharmacology ; Cross-Sectional Studies ; Demographic aspects ; Dosage and administration ; Drug therapy ; Factor Xa Inhibitors ; Female ; Fondaparinux ; Humans ; Linear Models ; Male ; Middle Aged ; Obesity, Morbid - complications ; Overweight persons ; Polysaccharides - pharmacology ; Prevention ; Retrospective Studies ; Risk Factors ; Venous Thromboembolism - prevention & control ; Venous thrombosis ; Young Adult</subject><ispartof>American journal of health-system pharmacy, 2011-09, Vol.68 (18), p.1716-1722</ispartof><rights>COPYRIGHT 2011 Oxford University Press</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c418t-622bcb309297d9d18aaac95b177f7303c1802a8085c0129473c7bb8d0278f2fa3</citedby><cites>FETCH-LOGICAL-c418t-622bcb309297d9d18aaac95b177f7303c1802a8085c0129473c7bb8d0278f2fa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21880887$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Martinez, Larissa</creatorcontrib><creatorcontrib>Burnett, Allison</creatorcontrib><creatorcontrib>Borrego, Matthew</creatorcontrib><creatorcontrib>Streeter, Jessica C</creatorcontrib><creatorcontrib>Townsend, Kelly</creatorcontrib><creatorcontrib>Garcia, David</creatorcontrib><title>Effect of fondaparinux prophylaxis on anti-factor Xa concentrations in patients with morbid obesity</title><title>American journal of health-system pharmacy</title><addtitle>Am J Health Syst Pharm</addtitle><description>Anti-factor Xa values in morbidly obese patients receiving standard doses of fondaparinux sodium for the prevention of venous thromboembolism (VTE) were analyzed in a retrospective chart evaluation.
The administration of low-molecular-weight heparins to obese patients (body mass index [BMI] of ≥30 kg/m(2)) at the dose recommended for VTE prophylaxis has been reported to result in increased thromboembolic events and decreased anti-factor Xa levels, and some evidence indicates that weight-based dosing adjustments may be appropriate. To study this phenomenon among morbidly obese patients (BMI of ≥40 kg/m(2)), a review of the charts of 45 adult patients for whom steady-state anti-factor Xa laboratory values were obtained after at least four fondaparinux injections was conducted; in all instances, fondaparinux sodium was given at the standard dose (2.5 mg once daily). Of the total of 47 anti-factor Xa values analyzed, 22 (47%) were below the study institution's target peak range (0.3-0.5 mg/L), 20 values (43%) were within the range, and 5 (11%) were above the range. No documented thromboembolic events occurred during hospitalization in the cases evaluated. A stepwise linear regression analysis of selected demographic and clinical variables indicated that better renal function, male sex, increased BMI, and fewer fondaparinux doses were associated with a greater likelihood of diminished anti-factor Xa activity in the cases evaluated.
Anti-factor Xa concentrations in morbidly obese patients receiving fondaparinux sodium 2.5 mg subcutaneously daily for VTE prophylaxis were within or above the target range in 53% of the instances evaluated.</description><subject>Adult</subject><subject>Aged</subject><subject>Anticoagulants - pharmacology</subject><subject>Cross-Sectional Studies</subject><subject>Demographic aspects</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Factor Xa Inhibitors</subject><subject>Female</subject><subject>Fondaparinux</subject><subject>Humans</subject><subject>Linear Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Obesity, Morbid - complications</subject><subject>Overweight persons</subject><subject>Polysaccharides - pharmacology</subject><subject>Prevention</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Venous Thromboembolism - prevention & control</subject><subject>Venous thrombosis</subject><subject>Young Adult</subject><issn>1079-2082</issn><issn>1535-2900</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kVFrFTEQhYMotlZf_AES8KEibE2ydzfZx1KqFgq-tOBbmM0m3ZTdZE1y2d5_71xutQhS8jDD8E04Zw4h7zk7E3zTfoH7ceGcMc5ekGPe1E0lOsZeYs9kVwmmxBF5k_M9EkKx9jU5ElwpppQ8JubSOWsKjY66GAZYIPmwfaBLisu4m-DBZxoDhVB85cCUmOhPoCYGY0NJUHwMmfpAF2xxkunqy0jnmHo_0Njb7MvuLXnlYMr23WM9IbdfL28uvlfXP75dXZxfV2bDValaIXrT16wTnRy6gSsAMF3TcymdrFltuGICUHdj0Ei3kbWRfa8GJqRywkF9Qk4P_6L4X1ubi559NnaaINi4zRoNN4xJtkHy07MkV52sFSrZox8P6B1MVvvgIto2e1yfC4n3lFJwpM7-Q-Eb7OzxWtZ5nP-z8PmwYFLMOVmnl-RnSDvNmd6nqp9SRfjDo9xtP9vhL_onxifno78bV5-szjNME-JCr-vaKnSkueRt_RvT6qly</recordid><startdate>20110915</startdate><enddate>20110915</enddate><creator>Martinez, Larissa</creator><creator>Burnett, Allison</creator><creator>Borrego, Matthew</creator><creator>Streeter, Jessica C</creator><creator>Townsend, Kelly</creator><creator>Garcia, David</creator><general>American Society of Health-System Pharmacists</general><general>Oxford University Press</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><scope>7TS</scope><scope>7X8</scope></search><sort><creationdate>20110915</creationdate><title>Effect of fondaparinux prophylaxis on anti-factor Xa concentrations in patients with morbid obesity</title><author>Martinez, Larissa ; Burnett, Allison ; Borrego, Matthew ; Streeter, Jessica C ; Townsend, Kelly ; Garcia, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c418t-622bcb309297d9d18aaac95b177f7303c1802a8085c0129473c7bb8d0278f2fa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anticoagulants - pharmacology</topic><topic>Cross-Sectional Studies</topic><topic>Demographic aspects</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Factor Xa Inhibitors</topic><topic>Female</topic><topic>Fondaparinux</topic><topic>Humans</topic><topic>Linear Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Obesity, Morbid - complications</topic><topic>Overweight persons</topic><topic>Polysaccharides - pharmacology</topic><topic>Prevention</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Venous Thromboembolism - prevention & control</topic><topic>Venous thrombosis</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Martinez, Larissa</creatorcontrib><creatorcontrib>Burnett, Allison</creatorcontrib><creatorcontrib>Borrego, Matthew</creatorcontrib><creatorcontrib>Streeter, Jessica C</creatorcontrib><creatorcontrib>Townsend, Kelly</creatorcontrib><creatorcontrib>Garcia, David</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of health-system pharmacy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Martinez, Larissa</au><au>Burnett, Allison</au><au>Borrego, Matthew</au><au>Streeter, Jessica C</au><au>Townsend, Kelly</au><au>Garcia, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of fondaparinux prophylaxis on anti-factor Xa concentrations in patients with morbid obesity</atitle><jtitle>American journal of health-system pharmacy</jtitle><addtitle>Am J Health Syst Pharm</addtitle><date>2011-09-15</date><risdate>2011</risdate><volume>68</volume><issue>18</issue><spage>1716</spage><epage>1722</epage><pages>1716-1722</pages><issn>1079-2082</issn><eissn>1535-2900</eissn><abstract>Anti-factor Xa values in morbidly obese patients receiving standard doses of fondaparinux sodium for the prevention of venous thromboembolism (VTE) were analyzed in a retrospective chart evaluation.
The administration of low-molecular-weight heparins to obese patients (body mass index [BMI] of ≥30 kg/m(2)) at the dose recommended for VTE prophylaxis has been reported to result in increased thromboembolic events and decreased anti-factor Xa levels, and some evidence indicates that weight-based dosing adjustments may be appropriate. To study this phenomenon among morbidly obese patients (BMI of ≥40 kg/m(2)), a review of the charts of 45 adult patients for whom steady-state anti-factor Xa laboratory values were obtained after at least four fondaparinux injections was conducted; in all instances, fondaparinux sodium was given at the standard dose (2.5 mg once daily). Of the total of 47 anti-factor Xa values analyzed, 22 (47%) were below the study institution's target peak range (0.3-0.5 mg/L), 20 values (43%) were within the range, and 5 (11%) were above the range. No documented thromboembolic events occurred during hospitalization in the cases evaluated. A stepwise linear regression analysis of selected demographic and clinical variables indicated that better renal function, male sex, increased BMI, and fewer fondaparinux doses were associated with a greater likelihood of diminished anti-factor Xa activity in the cases evaluated.
Anti-factor Xa concentrations in morbidly obese patients receiving fondaparinux sodium 2.5 mg subcutaneously daily for VTE prophylaxis were within or above the target range in 53% of the instances evaluated.</abstract><cop>England</cop><pub>American Society of Health-System Pharmacists</pub><pmid>21880887</pmid><doi>10.2146/ajhp110010</doi><tpages>7</tpages></addata></record> |
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| source | Journals@Ovid Ovid Autoload; Oxford University Press Journals All Titles (1996-Current); MEDLINE |
| subjects | Adult Aged Anticoagulants - pharmacology Cross-Sectional Studies Demographic aspects Dosage and administration Drug therapy Factor Xa Inhibitors Female Fondaparinux Humans Linear Models Male Middle Aged Obesity, Morbid - complications Overweight persons Polysaccharides - pharmacology Prevention Retrospective Studies Risk Factors Venous Thromboembolism - prevention & control Venous thrombosis Young Adult |
| title | Effect of fondaparinux prophylaxis on anti-factor Xa concentrations in patients with morbid obesity |
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