Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients
Background: Despite thromboprophylaxis, postoperative deep vein thrombosis and pulmonary embolism occur after bariatric surgery, perhaps because of failure to achieve optimal prophylactic levels in the obese population. Objectives: The aim of this study was to evaluate the adequacy of prophylactic d...
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| Format: | Article |
| Language: | English |
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Elsevier
2020
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| Online Access: | http://psasir.upm.edu.my/id/eprint/87951/ http://psasir.upm.edu.my/id/eprint/87951/1/ABSTRACT.pdf |
| _version_ | 1848860528846307328 |
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| author | Karas, Linden A. Nor Hanipah, Zubaidah Cetin, Derrick Schauer, Philip R. Brethauer, Stacy A. Daigle, Christopher R. Aminian, Ali |
| author_facet | Karas, Linden A. Nor Hanipah, Zubaidah Cetin, Derrick Schauer, Philip R. Brethauer, Stacy A. Daigle, Christopher R. Aminian, Ali |
| author_sort | Karas, Linden A. |
| building | UPM Institutional Repository |
| collection | Online Access |
| description | Background: Despite thromboprophylaxis, postoperative deep vein thrombosis and pulmonary embolism occur after bariatric surgery, perhaps because of failure to achieve optimal prophylactic levels in the obese population. Objectives: The aim of this study was to evaluate the adequacy of prophylactic dosing of enoxaparin in patients with severe obesity by performing an antifactor Xa (AFXa) assay. Setting: An academic medical center. Methods: In this observational study, all bariatric surgery cases at an academic center between December 2016 and April 2017 who empirically received prophylactic enoxaparin (adjusted by body mass index [BMI] threshold of 50 kg/m2) were studied. The AFXa was measured 3–5 hours after the second dose of enoxaparin. Results: A total of 105 patients were included; 85% were female with a median age of 47 years. In total, 16 patients (15.2%) had AFXa levels outside the prophylactic range: 4 (3.8%) cases were in the subprophylactic and 12 (11.4%) cases were in the supraprophylactic range. Seventy patients had a BMI <50 kg/m2 and empirically received enoxaparin 40 mg every 12 hours; AFXa was subprophylactic in 4 (5.7%) and supraprophylactic in 6 (8.6%) of these patients. Of the 35 patients with a BMI ≥50 who empirically received enoxaparin 60 mg q12h, no AFXa was subprophylactic and 6 (17.1%) were supraprophylactic. Five patients (4.8%) had major bleeding complications. One patient developed pulmonary embolism on postoperative day 35. Conclusion: BMI-based thromboprophylactic dosing of enoxaparin after bariatric surgery could be suboptimal in 15% of patients with obesity. Overdosing of prophylactic enoxaparin can occur more commonly than underdosing. AFXa testing can be a practical way to measure adequacy of pharmacologic thromboprophylaxis, especially in patients who are at higher risk for venous thromboembolism or bleeding. |
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| format | Article |
| id | upm-87951 |
| institution | Universiti Putra Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-15T12:46:40Z |
| publishDate | 2020 |
| publisher | Elsevier |
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| spelling | upm-879512022-05-24T08:07:48Z http://psasir.upm.edu.my/id/eprint/87951/ Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients Karas, Linden A. Nor Hanipah, Zubaidah Cetin, Derrick Schauer, Philip R. Brethauer, Stacy A. Daigle, Christopher R. Aminian, Ali Background: Despite thromboprophylaxis, postoperative deep vein thrombosis and pulmonary embolism occur after bariatric surgery, perhaps because of failure to achieve optimal prophylactic levels in the obese population. Objectives: The aim of this study was to evaluate the adequacy of prophylactic dosing of enoxaparin in patients with severe obesity by performing an antifactor Xa (AFXa) assay. Setting: An academic medical center. Methods: In this observational study, all bariatric surgery cases at an academic center between December 2016 and April 2017 who empirically received prophylactic enoxaparin (adjusted by body mass index [BMI] threshold of 50 kg/m2) were studied. The AFXa was measured 3–5 hours after the second dose of enoxaparin. Results: A total of 105 patients were included; 85% were female with a median age of 47 years. In total, 16 patients (15.2%) had AFXa levels outside the prophylactic range: 4 (3.8%) cases were in the subprophylactic and 12 (11.4%) cases were in the supraprophylactic range. Seventy patients had a BMI <50 kg/m2 and empirically received enoxaparin 40 mg every 12 hours; AFXa was subprophylactic in 4 (5.7%) and supraprophylactic in 6 (8.6%) of these patients. Of the 35 patients with a BMI ≥50 who empirically received enoxaparin 60 mg q12h, no AFXa was subprophylactic and 6 (17.1%) were supraprophylactic. Five patients (4.8%) had major bleeding complications. One patient developed pulmonary embolism on postoperative day 35. Conclusion: BMI-based thromboprophylactic dosing of enoxaparin after bariatric surgery could be suboptimal in 15% of patients with obesity. Overdosing of prophylactic enoxaparin can occur more commonly than underdosing. AFXa testing can be a practical way to measure adequacy of pharmacologic thromboprophylaxis, especially in patients who are at higher risk for venous thromboembolism or bleeding. Elsevier 2020 Article PeerReviewed text en http://psasir.upm.edu.my/id/eprint/87951/1/ABSTRACT.pdf Karas, Linden A. and Nor Hanipah, Zubaidah and Cetin, Derrick and Schauer, Philip R. and Brethauer, Stacy A. and Daigle, Christopher R. and Aminian, Ali (2020) Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients. Surgery for Obesity and Related Diseases, 17 (1). 153 - 160. ISSN 1550-7289; ESSN: 1878-7533 https://www.sciencedirect.com/science/article/abs/pii/S1550728920304810 10.1016/j.soard.2020.08.016 |
| spellingShingle | Karas, Linden A. Nor Hanipah, Zubaidah Cetin, Derrick Schauer, Philip R. Brethauer, Stacy A. Daigle, Christopher R. Aminian, Ali Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients |
| title | Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients |
| title_full | Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients |
| title_fullStr | Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients |
| title_full_unstemmed | Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients |
| title_short | Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients |
| title_sort | assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor xa in high-risk patients |
| url | http://psasir.upm.edu.my/id/eprint/87951/ http://psasir.upm.edu.my/id/eprint/87951/ http://psasir.upm.edu.my/id/eprint/87951/ http://psasir.upm.edu.my/id/eprint/87951/1/ABSTRACT.pdf |