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?
There is NO maximum enoxaparin dose for treatment of VTE.
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. 
- 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.
- 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]