Weight-based enoxaparin dosing for venous thromboembolism prophylaxis in the obese trauma patient

Am J Surg. 2013 Dec;206(6):847-51, discussion 851-2. doi: 10.1016/j.amjsurg.2013.07.020. Epub 2013 Sep 24.


Background: Limited data exist regarding the efficacy of weight-based dosing of low-molecular weight heparin for venous thromboembolism (VTE) prophylaxis in obese trauma patients.

Methods: Consecutive obese trauma patients were placed on a weight-based protocol for VTE prophylaxis (enoxaparin .5 mg/kg subcutaneously every 12 hours). Peak anti-Xa levels were drawn, and bilateral lower extremity duplex ultrasound was performed. The incidence of VTE and bleeding complications were recorded.

Results: Eighty-six patients met the study criteria. Seventy-four patients achieved target prophylactic anti-Xa concentrations, with a mean level of .42 ± .01 IU/mL. Eighteen patients were found to have deep vein thrombosis. However, in 16 of these patients, deep vein thrombosis was diagnosed before weight-based low-molecular weight heparin initiation. No bleeding complications occurred, and no symptomatic pulmonary emboli were identified.

Conclusions: In obese trauma patients, weight-based enoxaparin is an efficacious regimen that provides adequate VTE prophylaxis, as measured by anti-Xa levels, and appears to be safe without bleeding complications.

Keywords: Anti-Xa level; Enoxaparin; Obese; Trauma; VTE prophylaxis; Venous thromboembolism prophylaxis.

Publication types

  • Comparative Study

MeSH terms

  • Anticoagulants / administration & dosage
  • Body Mass Index
  • Dose-Response Relationship, Drug
  • Enoxaparin / administration & dosage*
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Subcutaneous
  • Leg / blood supply
  • Male
  • Middle Aged
  • Obesity / complications*
  • Retrospective Studies
  • Treatment Outcome
  • Ultrasonography, Doppler, Duplex
  • Venous Thromboembolism / diagnostic imaging
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control*
  • Wounds and Injuries / complications*


  • Anticoagulants
  • Enoxaparin