2025 Southeastern Residency Conference

Title: An Evaluation of Prophylactic Enoxaparin Dosing in Patients with Obesity
 
Authors: Jeff Bruni, Elizabeth Oglesby, Hong Duong, Makayla Sborov, Catherine Childre, Will Johnson
 
Background:  Enoxaparin is routinely prescribed for patients to prevent deep vein thromboses (DVTs). While the current prophylactic dosing strategy of enoxaparin is seemingly concise for adults, the optimal dosing for patients with obesity is not well established. Standard enoxaparin (Lovenox) doses may be inadequate in this patient population, requiring weight-based adjustments for effective anticoagulation.
 
Methods: A retrospective study of inpatient adults with obesity was performed on patients admitted to the infirmary Health system with an order of enoxaparin for VTE prophylaxis. Data was randomly collected from a total of 466 patients with obesity over a period of 6 months from January 1, 2024, to June 30, 2024. Obesity was defined as BMI greater than or equal to 30 kg/m^2. Study variables collected included demographics, length of stay, medical history (including previous history of stroke or VTE), admitting diagnosis, and baseline weight in kilograms. The primary outcome was development of VTE during hospital encounter or within thirty days of discharge. Dosing strategies evaluated included: enoxaparin 30 mg, 40 mg, or 60 mg at a frequency of either daily or twice daily. Secondary outcomes included major bleeding, minor bleeding, ischemic stroke, and all-cause mortality. Patients who were pregnant, who had a serum creatinine greater than 2mg/dL, who were prescribed enoxaparin with the intent of VTE treatment, or who had documented heparin-induced thrombocytopenia prior to or during treatment were excluded.
 
Results: A total of 466 patients were prescribed enoxaparin for prophylaxis between the designated time frame. 131 of those patients met exclusion criteria. Of the 335 patients included, a total of 9 experienced a VTE within 30 days (providing an overall VTE rate of 2.7%).
 
Conclusion: The evaluated study population had a low rate of VTE irrespective of enoxaparin dosing strategy, admitting diagnosis, or BMI when compared to the national average. A superior dosing regimen for prescribing prophylactic enoxaparin in patients with obesity remains to be unclear.