TY - JOUR
T1 - A Clinical Practice-Based Comparison of Conventional and Individualized Dosing Strategies for Therapeutic Enoxaparin
AU - Damiani, Anthony
AU - De Menezes Caceres, Viviane
AU - Roberts, Greg
AU - Coddo, Jessica
AU - Scarfo, Nicholas
AU - Willliams, Desmond B.
AU - Tharmathurai, Vinosshini
AU - Tadros, Rami
AU - Fitzgerald, Stephen
AU - O'Connell, Alice
AU - Kaur Sandhu, Amrit
AU - Vanlint, Andrew
AU - Mangoni, Arduino A.
AU - Hofmann, Dirk
AU - Bony, Hosam
AU - Faunt, Jeff
AU - Boey, Jir Ping
AU - Farinola, Nicholas
AU - Wells, Rachel
AU - Hedger, Stephen
AU - Hewage, Udul
AU - Sharma, Yogesh
AU - Jabbar, Zuhair
AU - Thomas, Josephine
AU - Flabouris, Katerina
AU - Gilbert, Toby
AU - Thompson, Campbell
AU - Russell, Patrick
PY - 2025/2
Y1 - 2025/2
N2 - 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.
AB - 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.
KW - enoxaparin
KW - factor Xa
KW - low-molecular-weight heparin
UR - http://www.scopus.com/inward/record.url?scp=85216106801&partnerID=8YFLogxK
U2 - 10.1002/prp2.70039
DO - 10.1002/prp2.70039
M3 - Article
AN - SCOPUS:85216106801
SN - 2052-1707
VL - 13
JO - Pharmacology Research and Perspectives
JF - Pharmacology Research and Perspectives
IS - 1
M1 - e70039
ER -