Adjusted value of thromboprophylaxis in hospitalized obese patients: A comparative study of two regimens of enoxaparin: The ITOHENOX study

作者：Miranda Sebastien; Le Cam Duchez Veronique; Benichou Jacques; Donnadieu Nathalie; Barbay Virginie; Le Besnerais Maelle; Delmas Francois Xavier; Cuvelier Antoine; Levesque Herve; Benhamou Ygal; Armengol Guillaume^*

来源：Thrombosis Research, 2017, 155: 1-5.

DOI：10.1016/j.thromres.2017.04.011

• Thromboembolism prophylaxis
• Obesity
• Special population
• Enoxaparin
• Low-molecular weight heparin
• Weight-adapted regimen

Thromboprophylaxis is a mainstay of hospital care in patients at high risk of thrombosis. Fixed doses of lowmolecular-weight heparin (LMWH) are recommended for thromboprophylaxis in patients admitted to hospital for an acute medical condition. However, the distribution of LMWHisweight-based, and the efficacy of standard doses in obese patients may be decreased. Data for obese patients are mainly available in bariatric surgery with extremely obese patientswho are at greater risk of venous thromboembolismthan those hospitalized for amedical condition. Weconducted a randomized control trial inmedically obese inpatients (BMI >= 30 kg/m(2)) assessing two regimens of enoxaparin (40 mg and 60mg SQ daily) in order to determinewhether a stronger dosagewould achieve higher anti-Xa level suitable for thromboprophylaxis. Between September 2013 and April 2015, 91 patients were included in the study (mean (+/- standard deviation) age was 70.4 +/- 10.7 years, average BMI 37.8 +/- 6.4 kg/m(2)). Main indications of thromboprophylaxisweremainly acute infection (50%), acute respiratory failure (10%), acute congestive heart failure (9%) and acute rheumatic disorders (18%).
Average anti-Xa activity, measured 4 h after the third administration of enoxaparin was 0.25 +/- 0.09 IU/mL in group 1 (enoxaparin 40 mg) and 0.35 +/- 0.13 IU/mL in group 2 (enoxaparin 60 mg) (P < 10(-3)). The proportions of patients with normal anti-Xa activity (between 0.32 and 0.54 IU/mL) were 31% (n= 11) and 69% (n= 24) in group 1 and 2 respectively (P = 0.007). The proportions of anti-Xa activitymeasurement belowthe normal range were 64% and 36% in group 1 and 2 (P < 10(-3)) respectively. Subgroup analysis focusing on high weight patients (above 100 kg, n = 45) showed a marked difference in the proportion of patients with normal anti-Xa activity between group 1 (9%) and 2 (44%) (P = 0.009). No venous thromboembolism occurred during the study and one patient in group 1 died because of hemorrhagic shock due to a gastric ulcer. Incidence of adverse events was not different between the two groups (P = 0.52).
In conclusion, the ITOHENOX study shows in medically obese inpatients that thromboprophylaxis with enoxaparin 60 mg provides higher control of anti-Xa activity, without more bleeding complications than the standard enoxaparin regimen. This trial is registered with ClinicalTrials. gov, number NCT01707732.

• 出版日期2017-7