Anti-factor Xa Activity of Enoxaparin for Thromboprophylaxis in Nonsurgical Patients Is Dependent on Body Mass

Jiménez, David; Díaz, Gema; Iglesias, Ana; César, Jesús; García-Avello, Ángel; Martí, David; Escobar, Carlos; Vidal, Rafael; Sueiro, Antonio

doi:10.1016/S1579-2129(09)60003-3

Article information

Objective

Thromboprophylaxis with fixed doses of low molecular weight heparin is recommended for hospitalized acutely ill medical patients. The purpose of this study was to assess whether the anti-factor Xa (anti-Xa) activity of enoxaparin prescribed for venous thromboembolism prophylaxis depends on body mass index (BMI) in patients hospitalized for an acute respiratory disease.

Patients and methods

All patients admitted by the respiratory medicine department (January-December 2006) for an acute respiratory disease, and for whom pharmacologic thromboprophylaxis was indicated, were included in the study. Anti-Xa activity was measured 4 hours after administration of enoxaparin on the third day of hospitalization. The primary outcome was anti-Xa activity in relation to BMI.

Results

One hundred twelve patients were enrolled. Mean anti-Xa activity decreased with each BMI quartile(0.28, 0.23, 0.15 and 0.13 U/mL for quartiles 1, 2, 3, and 4, respectively). In the multivariate analysis, BMI was the only predictor of inadequate anti-Xa activity (odds ratio, 1.14; 95% confidence interval, 10.5-1.24; P<.002) after adjustment for age, sex, and serum creatinine concentration. Two episodes of symptomatic proximal deep vein thrombosis were observed in the month after hospitalization; both were in patients who had inadequate anti-Xa activity.

Conclusions

Anti-Xa activity is dependent on BMI in hospitalized acute medical patients receiving enoxaparin for thromboprophylaxis.

Key words:

Enoxaparin

Thromboprophylaxis

Acute medical condition

Objetivo

Se recomienda la tromboprofilaxis con heparina de bajo peso molecular a dosis fijas en pacientes médicos agudos que requieran ingreso hospitalario. El objetivo de este estudio ha sido determinar si la actividad antifactor Xa de la enoxaparina depende del peso corporal cuando se administra a pacientes hospitalizados por un proceso respiratorio agudo como profilaxis de la enfermedad tromboembólica venosa.

Pacientes y métodos

Se incluyó prospectivamente en el estudio a todos los pacientes ingresados en el Servicio de Neumología entre enero y diciembre de 2006 por un proceso respiratorio agudo con indicación de tromboprofilaxis farmacológica. Se determinó la actividad anti-Xa 4 h después de la administración de la enoxaparina, en el tercer día de ingreso hospitalario. El criterio de evaluación principal fue la actividad anti-Xa en función del índice de masa corporal (IMC).

Resultados

Se incluyó a 112 pacientes en el estudio. La actividad anti-Xa media disminuyó a medida que aumentaban los cuartiles de IMC (0,28, 0,23, 0,15 y 0,13 U/ml para los cuartiles 1, 2, 3 y 4, respectivamente). En el análisis multivariable, el IMC fue la única variable predictora de actividad anti-Xa insuficiente (odds ratio = 1,14; intervalo de confianza del 95%, 1,05-1,24; p < 0,002), después de ajustar por la edad, el sexo y la creatinina sérica. Hubo 2 episodios sintomáticos de trombosis venosa profunda proximal en el mes posterior al ingreso hospitalario, ambos en pacientes con actividad anti-Xa insuficiente.

Conclusiones

La actividad anti-Xa de la enoxaparina depende del IMC en los pacientes que reciben tromboprofilaxis por un proceso médico agudo que requiera hospitalización.

Palabras clave:

Enoxaparina

Tromboprofilaxis

Proceso médico agudo

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A grant to support this research was received from the Society of Pulmonology and Thoracic Surgery of Madrid (NEUMOMADRID).

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