Dosing of Enoxaparin in Morbidly Obese Patients: A Retrospective Cohort.

Purpose: The purpose of this study was to evaluate odds of major bleeding, thrombosis, and ischemic stroke between different enoxaparin dosage strategies in patients weighing ≥120 kg. Methods: Patients weighing ≥120 kg who received therapeutic anticoagulation with enoxaparin for more than 24 hours were selected for retrospective review. Patients without a baseline weight, serum creatinine, a history of heparin-induced thrombocytopenia, or currently pregnant patients were excluded from the study. Patients with a creatinine clearance (CrCL) <30 mL/min were analyzed separately. The incidence of major bleeding was compared between patients receiving <90% and those receiving ≥90% of the Food and Drug Administration (FDA)-approved dose of enoxaparin, as well as between patients weighing ≥150 kg and those weighing <150 kg. Secondary outcomes included incidence of venous thromboembolism (VTE) and ischemic stroke. Results: A total of 462 patients were included in the primary analysis and 25 patients in the subgroup analysis. No difference in major bleeding was observed between different dosage regimens ( P = .12) or weight groups ( P = .36). No difference was observed in rates of VTE or ischemic stroke between different dosage regimens ( P = .52 and P = .60, respectively) or weight groups ( P = .39 and P = .48, respectively). Similar results were observed in the low-CrCL analysis. Results were not altered when patients were propensity matched on baseline characteristics. Conclusion: Reducing the dose of enoxaparin did not reduce the odds of major bleeding or increase the odds of ischemic stroke or VTE.