26/12/2021
Venous Thromboembolism ( VTE ) PROPHYLAXIS DOSING IN OBESITY :
• Appropriate VTE prophylaxis dosing in obesity is challenging due to pharmacokinetic and drug distribution changes that occur from increased adipose tissue and increased total drug clearance compared to non-obese patients.
• There is limited literature supporting higher VTE prophylaxis dosing regimens in obese patients reduce the risk of nosocomial VTE.
• For patients with BMI >40 kg/m2 who require subcutaneous heparin for VTE prophylaxis (e.g. impaired renal function), high-dose heparin (7500 units every 8 hours) was shown to reduce the incidence of nosocomial VTE compared with usual-dose heparin (5000 units every 8 hours).
• Other studies have failed to show a reduction in VTE with high-dose.
• There is conflicting evidence on whether high-dose heparin increases the risk of major bleeding
• For obese patients able to receive enoxaparin VTE prophylaxis, higher than usual dosing regimens reduce the risk of VTE and increase the likelihood of peak anti-factor Xa target attainment (0.2 to 0.5 IU/mL).
* BMI ≥40 kg/m2: enoxaparin 40 mg twice daily
* BMI ≥50 kg/m2: enoxaparin 60 mg twice daily
* Peak anti-factor Xa levels may be monitored 4-6 hours after the third or fourth dose of enoxaparin. Adjust total daily dose by 10-20% when anti-factor Xa levels are either above or below the target range.
Ref:
criticalcarenow.com
