Efficacy and Safety of High Doses of Enoxaparin in Preventing Thromboembolic Disease in Morbidly Obese Patients

Introduction

Obesity Class III, also known as morbid obesity, is characterized by a BMI ≥ 40 kg/m². Currently, it is regarded as a very serious condition that increases morbidity and mortality and lowers the quality of life. All degrees of obesity are among the risk factors for the development of thromboembolic disease.

Previous studies have explored various prophylactic strategies for thromboembolic disease in hospitalized morbidly obese individuals. However, until now, it has not been clear whether the optimal prophylaxis for these patients is unfractionated heparin at a fixed high dose or low molecular weight heparin enoxaparin at a fixed high dose.

Study Design and Objectives

The study, conducted at a single center, included 305 morbidly obese patients with BMI ≥ 40 who were assigned thromboprophylaxis with either enoxaparin 40 mg every 12 hours (n = 115) or unfractionated heparin 7500 U every 8 hours (n = 190). Primary objectives of the study were to evaluate the occurrence of thromboembolic and major bleeding events during hospitalization.

Results

Patients receiving unfractionated heparin prophylaxis showed a significantly higher incidence of major bleeding compared to those on enoxaparin (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.07–3.13; p = 0.025). No statistically significant difference was observed in the incidence of thromboembolic events. The only independent predictors of major bleeding were intensive care (OR 3.32; 95% CI 1.91–5.78; p < 0.001) and the use of unfractionated heparin instead of enoxaparin for thromboprophylaxis (OR 2.16; 95% CI 1.22–3.82; p = 0.008).

Conclusion

The study results indicate that high-dose enoxaparin is as effective as high-dose unfractionated heparin in preventing thromboembolic disease in morbidly obese patients. However, enoxaparin administration is associated with a significantly lower incidence of major bleeding compared to unfractionated heparin.

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Source: Mason S. W., Barber A., Jones E. et al. Safety and efficacy of high-dose unfractionated heparin versus high-dose enoxaparin for venous thromboembolism prevention in morbidly obese hospitalized patients. Am J Med 2019 Dec 17, pii: S0002-9343(19)31093-9, doi: 10.1016/j.amjmed.2019.12.003 [Epub ahead of print].