A Clinical Practice-Based Comparison of Conventional and Individualized Dosing Strategies for Therapeutic Enoxaparin

Anthony Damiani, Viviane De Menezes Caceres, Greg Roberts, Jessica Coddo, Nicholas Scarfo, Desmond B. Willliams, Vinosshini Tharmathurai, Rami Tadros, Stephen Fitzgerald, Alice O'Connell, Amrit Kaur Sandhu, Andrew Vanlint, Arduino A. Mangoni, Dirk Hofmann, Hosam Bony, Jeff Faunt, Jir Ping Boey, Nicholas Farinola, Rachel Wells, Stephen HedgerUdul Hewage, Yogesh Sharma, Zuhair Jabbar, Josephine Thomas, Katerina Flabouris, Toby Gilbert, Campbell Thompson, Patrick Russell

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Abstract

To understand differences in anti-factor-Xa levels produced by two different dosing strategies (conventional and individualized) for therapeutic enoxaparin in a cohort of hospital inpatients. A multicenter, retrospective cohort study over a two- and a half-year period for inpatients with stable renal function and on therapeutic enoxaparin. Anti-factor-Xa levels were taken 3–5 h after enoxaparin administration and a minimum of 48 h of dosing. The final analysis included 278 patients from five hospitals: conventional dosing was used for 141, while 137 were given an unconventional dose, that is, individualized for their renal function and weight. Out-of-range levels were frequent (35% to 40% of all inpatients). After adjustment for age, renal function, and body mass index (BMI), the conventional group was more likely to experience above-range levels (> 1.0 IU/mL; OR 2.50 [95% CI 1.38–4.56], p < 0.003) than the individualized group. Individualized dosing was independently associated with higher odds of a below-range anti-Xa level (< 0.5 IU/mL) compared to conventional dosing (OR 2.27 [95% CI 1.07–4.76], p = 0.03). Within the conventional group, above-range levels were significantly and independently associated with decreasing renal function (OR 0.97, 95% CI 0.96–0.99, p = 0.004) and with increasing BMI (OR 1.06, 95% CI 1.01–1.10, p = 0.02). No such associations were seen with an individualized approach. Clinical event rates were low and not different between groups (p > 0.24). Conventional therapeutic dosing of enoxaparin exposed people with obesity or renal impairment to more frequent above-range anti-factor-Xa levels; individualizing the dose could improve this but might expose people to subtherapeutic levels. More research is needed.

Original languageEnglish
Article numbere70039
Number of pages9
JournalPharmacology Research and Perspectives
Volume13
Issue number1
DOIs
Publication statusPublished - Feb 2025

Keywords

  • enoxaparin
  • factor Xa
  • low-molecular-weight heparin

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