Dosing of Enoxaparin in Morbidly Obese Patients: A Retrospective Cohort

The purpose of this study was to evaluate odds of major bleeding, thrombosis, and ischemic stroke between different enoxaparin dosage strategies in patients weighing ≥120 kg. Patients weighing ≥120 kg who received therapeutic anticoagulation with enoxaparin for more than 24 hours were selected for retrospective review. Patients without a baseline weight, serum creatinine, a history of heparin-induced thrombocytopenia, or currently pregnant patients were excluded from the study. Patients with a creatinine clearance (CrCL) <30 mL/min were analyzed separately. The incidence of major bleeding was compared between patients receiving <90% and those receiving ≥90% of the Food and Drug Administration (FDA)-approved dose of enoxaparin, as well as between patients weighing ≥150 kg and those weighing <150 kg. Secondary outcomes included incidence of venous thromboembolism (VTE) and ischemic stroke. A total of 462 patients were included in the primary analysis and 25 patients in the subgroup analysis. No difference in major bleeding was observed between different dosage regimens ( = .12) or weight groups ( = .36). No difference was observed in rates of VTE or ischemic stroke between different dosage regimens ( = .52 and = .60, respectively) or weight groups ( = .39 and = .48, respectively). Similar results were observed in the low-CrCL analysis. Results were not altered when patients were propensity matched on baseline characteristics. Reducing the dose of enoxaparin did not reduce the odds of major bleeding or increase the odds of ischemic stroke or VTE.