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Use of Enoxaparin in Obese Adolescents During Bariatric Surgery—a Pilot Study

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Abstract

Background

Obese patients have a higher risk of venous thromboembolism when immobilized due to surgery. The objective of this study was to assess anti-factor Xa activity in adolescent bariatric surgical patients receiving prophylactic enoxaparin.

Methods

Four morbidly obese adolescents undergoing laparoscopic sleeve gastrectomy were enrolled. Enoxaparin was administered (40 mg subcutaneous (SC) if BMI ≤50 kg/m2 or 60 mg SC if BMI >50 kg/m2) for prevention of venous thromboembolism every 12 h starting after induction of anesthesia until discharge. Plasma anti-factor Xa activity was assessed over 12 h after the first dose and used as a surrogate marker for enoxaparin levels. Non-compartmental analysis of anti-factor Xa activity levels was performed and compared with previously published studies.

Results

Patients recruited were 16 to 18 years of age with a mean BMI of 52.6 ± 5.8 kg/m2 (>99th BMI percentile). Peak anti-factor Xa activity ranged from 0.20 to 0.23 IU/mL in our study population, compared to 0.38 to 0.53 IU/mL in the cited lean comparator groups.

Conclusions

Our current dosing practice of 40 mg SC for individuals with a BMI ≤50 kg/m2 and 60 mg for individuals with a BMI ≥50 kg/m2 resulted in anti-factor Xa activity that was sufficient for adequate thromboprophylaxis in adolescent bariatric surgical patients. Our data also demonstrates lower drug exposures in the obese when compared to lean patients. Therefore, randomized controlled efficacy and safety studies are urgently needed to guide the use of low-molecular-weight heparins in the pediatric and adolescent obese population.

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Acknowledgments

We acknowledge Elaine Williams RN, MSN, for help with blood sample collection and support with study coordination. We also thank Dr. Nicole Verdun for help with planning study and assessing results.

Conflict of Interest

Dr. Alvina Mushtaq has nothing to disclose.

Dr. Janelle D. Vaughns has nothing to disclose.

Dr. Victoria C. Ziesenitz has nothing to disclose.

Dr. Evan P. Nadler has nothing to disclose.

Dr. John N. van den Anker has nothing to disclose.

Statement of Informed Consent

Informed consent and assent were obtained from all individual participants included in the study.

Statement of Human and Animal Rights

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee, with the 1964 Helsinki declaration and its later amendments, and national laws for data protection. Informed consent was obtained from all individual participants included in the study.

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Author notes

    Authors and Affiliations

    1. Clinical Pharmacology, Clinical and Translational Science Institute, Children’s National Medical Center, Washington, DC, USA

      Alvina Mushtaq, Victoria C. Ziesenitz & John N. van den Anker

    2. Anesthesiology, Sedation and Perioperative Medicine, Children’s National Medical Center, Washington, DC, USA

      Janelle D. Vaughns

    3. Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany

      Victoria C. Ziesenitz

    4. Surgery, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, Washington, DC, USA

      Evan P. Nadler

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    1. Alvina Mushtaq
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    Correspondence to Alvina Mushtaq.

    Additional information

    Alvina Mushtaq and Janelle D. Vaughns contributed equally to this work.

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    Mushtaq, A., Vaughns, J.D., Ziesenitz, V.C. et al. Use of Enoxaparin in Obese Adolescents During Bariatric Surgery—a Pilot Study. OBES SURG 25, 1869–1874 (2015). https://doi.org/10.1007/s11695-015-1630-x

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    • DOI: https://doi.org/10.1007/s11695-015-1630-x

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