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Fixed-Dose Enoxaparin After Bariatric Surgery: The Influence of Body Weight on Peak Anti-Xa Levels

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Abstract

Introduction

There is lack of data on the pharmacodynamics of low-molecular-weight heparins in obese patients.

Background

The aims of this study are to investigate the correlation between anti-factor Xa (anti-Xa) levels and body weight with fixed-dose enoxaparin after bariatric surgery and to investigate the percentage of patients that reach the desired prophylactic range for anti-Xa levels.

Methods

Blood for anti-Xa peak levels measurement was drawn 3–5 h after administration of enoxaparin at the planned visit 8–16 days after surgery. Patients were included in three categories: <110 kg (group 1), 110–150 kg (group 2), and >150 kg (group 3).

Results

Fifty-one patients were included (43.9 ± 9.9 years, 75 % women). Mean anti-Xa level was 0.37 ± 0.14 IU/ml. This level was the highest in group 1 (0.47 ± 0.13 IU/ml) and lowest in group 3 (0.23 ± 0.07). No subprophylactic (<0.2 IU/ml) anti-Xa levels were detected in group 1, whereas this was observed in 38 % in patients in group 3. Supraprophylactic levels (>0.5 IU/ml) were most often present in group 1 (36 %). With multivariable regression analysis, body weight (β −0.720 (95 % confidence interval −.717; −.993), p < 0.001) was an independent predictor of anti-Xa levels, whereas lean body was not independently associated. This was confirmed in a non-linear mixed effects analysis of the data.

Conclusions

Patients with excessive body weight may not be adequately treated with fixed-dose enoxaparin thromboprophylaxis while patients with lower body weight may have an increased bleeding risk. Body weight is a better predictor of anti-Xa levels compared to lean body weight.

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Conflict of Interest

The authors (Funda Celik, Alwin D. R. Huitema, Jan H. Hooijberg, Arnold W. J. M. van de Laar, Dees P. M. Brandjes, Victor E. A. Gerdes) certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human Rights

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Department of Internal Medicine, 9B, Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands

    Funda Celik, Dees P. M. Brandjes & Victor E. A. Gerdes

  2. Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Alwin D. R. Huitema

  3. Department of Clinical Chemistry and Hematology, Slotervaart Hospital, Amsterdam, The Netherlands

    Jan H. Hooijberg

  4. Department of Surgery, Slotervaart Hospital, Amsterdam, The Netherlands

    Arnold W. J. M. van de Laar

  5. Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands

    Dees P. M. Brandjes & Victor E. A. Gerdes

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  1. Funda Celik
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  2. Alwin D. R. Huitema
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Correspondence to Funda Celik.

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Celik, F., Huitema, A.D.R., Hooijberg, J.H. et al. Fixed-Dose Enoxaparin After Bariatric Surgery: The Influence of Body Weight on Peak Anti-Xa Levels. OBES SURG 25, 628–634 (2015). https://doi.org/10.1007/s11695-014-1435-3

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  • DOI: https://doi.org/10.1007/s11695-014-1435-3

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