In this episode, I’ll discuss whether the dose of enoxaparin for VTE prophylaxis can be reduced in low weight patients.
Shout out to “Pharmacy Jeff” for inspiring this episode!
When using enoxaparin for VTE prophylaxis in low-weight adults, doses can approach the 1 mg/kg normally associated with VTE treatment.
A long-standing practice among many clinicians has been to reduce a dose of enoxaparin 40 mg subcut daily for VTE prophylaxis to 30 mg in patients weighing under 45 kg.
In July of 2019, a retrospective cohort study was published that looked at this exact dosing regimen and compared it with patients under 45 kg who received no dose adjustment.
173 patients were analyzed. There was no difference in the incidence of major or minor bleeding by dose (enoxaparin 30 mg SC daily, 30 mg SC twice daily, or 40 mg SC daily). In addition, no patient in the cohort experienced a VTE event.
Patients who experienced major bleeding were older (54.9 ± 16.1 years) than patients who did not (48.4 ± 18.4 years), and this difference was statistically significant.
This study lends support to the empiric reduction of enoxaparin dose in low weight patients, especially those who are elderly.
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