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levels, even at reduced initial doses.9,10,21 However, reliance
on anti-Xa data as a surrogate endpoint is also limited by factors including lack of inter-laboratory agreement on levels
and lack of rigorous clinical data to justify the suggested
anti-Xa target ranges.28
Until further data emerge regarding empiric enoxaparin
dosing regimens in the morbidly obese population with acute
VTE, institutions will have to determine whether absolute
dose capping, reduced empiric weight-based regimens, or a
combination of approaches is most appropriate. ACCP recommendations for anti-Xa monitoring should still be followed.11 One consistent thread that has emerged through
recent data and case reports is the fact that morbidly obese
patients often require less than the routinely recommended
empiric therapeutic enoxaparin dosing of 1 mg/kg to achieve
anti-Xa levels within the accepted therapeutic range; however, further studies are needed to determine the optimal
empiric dose in morbidly obese patients and which specific
patients should receive dose reduction.

Conclusion
Therapeutic dose enoxaparin was used successfully in a morbidly obese patient at a weight-based dose of 0.85 mg/kg SQ
Q12 hours without the need for further adjustment. This case
provides additional evidence that reduced empiric dosing
may be an appropriate dosing strategy in the morbidly obese
population for the treatment of VTE.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs
Sheila M. Wilhelm
Sean M. McConachie

https://orcid.org/0000-0002-7045-6690
https://orcid.org/0000-0003-4889-7307

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https://www.orcid.org/0000-0002-7045-6690 https://www.orcid.org/0000-0003-4889-7307 http://www.cdc.gov/obesity/data/adult.html https://www.cdc.gov/nchs/data/hestat/obesity_adult_13_14/obesity_adult_13_14.htm https://www.cdc.gov/nchs/data/hestat/obesity_adult_13_14/obesity_adult_13_14.htm

Hospital Pharmacy - December 2019

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