Venous thromboembolism (VTE) is often treated with low molecular weight heparins (LMWH) such as enoxaparin. For patients with normal renal function, dosing is as follows:
  • Enoxaparin: 1 mg/kg subcutaneously every 12 hours, or 1.5 mg/kg every 24 hours
  • Dalteparin 200 IU/kg subcutaneously once daily
  • Tinzaparin: 175 IU/kg subcutaneously once daily

What about the obese patient? Is there a maximum dose for enoxaparin?

Myth busted

There is NO maximum enoxaparin dose for treatment of VTE.

Supporting Data

Studies have evaluated dosing for patients weighing up to 190 kg and found the 1 mg/kg q12 hour dosing to be safe and effective. It can even be used for patients heavier than 190 kg, but anti-Xa monitoring is recommended. [1]

Key Points

  • Dosing should be based on total body weight.
  • In patients with a BMI > 27, use the q12 hour dosing (not q24 hours).
  • Doses should not be capped for VTE treatment (studies differ on whether or not to cap in treatment of acute coronary syndrome).
  • In patients > 190 kg, it is recommended to monitor anti-Xa levels if available.

Reference

  1. Nutescu EA, et al. Low-molecular-weight heparins in renal impairment and obesity: available evidence and clinical practice recommendations across medical and surgical settings. Ann Pharmacother 2009;43(6):1064-83. [PMID 19458109]
Bryan D. Hayes, PharmD, FAACT, FASHP

Bryan D. Hayes, PharmD, FAACT, FASHP

Leadership Team, ALiEM
Creator and Lead Editor, Capsules series, ALiEMU
Attending Pharmacist, EM and Toxicology, MGH
Assistant Professor of EM, Harvard Medical School
Bryan D. Hayes, PharmD, FAACT, FASHP

@PharmERToxGuy

EM Pharmacist & Toxicologist @MassGeneralEM | Asst Prof @HarvardMed/@EMRES_MGHBWH | @ALiEMteam leadership | Capsules creator, ALiEMU | President, ABAT | #FOAMed