Abstract：
Enoxaparin is a hydrophilic drug with obesity having little effect on its apparent volume of distribution, therefore patients with obesity receiving standard 1 mg/kg dosing may be at a higher risk of supratherapeutic dosing. Conversely, dose reducing patients with obesity could place already at risk patients at higher risk of a thrombotic event. Data and recommendations are variable for the most appropriate weight-based dose of therapeutic enoxaparin in obese patients, particularly those a weight > 100 kg or a body mass index (BMI) ≥ 40 kg/m2. The purpose of this systematic review was to globally evaluate these data to surmise optimal dosing recommendations for patients with obesity. A systematic review of English language studies was conducted and identified articles via Pubmed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) searches. Studies were included if they reported therapeutic enoxaparin use in adult patients with a BMI ≥ 40 kg/m2 or body weight > 100 kg and the percentage of patients achieving a therapeutic anti-Xa based on a weight-based dose or the weight-based dose required to produce a therapeutic anti-Xa level. Therapeutic attainment of anti-Xa levels were assessed across enoxaparin weight-based dosing categories including a very low dose group: < 0.75 mg/kg, low dose group: 0.75-0.85 mg/kg, and standard dose group: ≥ 0.95 mg/kg. Rates of bleeding and thrombosis were also evaluated. A total of eight studies were included. For anti-Xa level assessment, 682 patients were included. A total of 62% of anti-Xa levels were therapeutic in the very low dose group, 66% in the low dose group, and 42% in the standard dose group. Overall rates of total bleeding and thrombosis were assessed in 798 patients. A total of 29 bleedings (3.6%) occurred, and 27 reported a relationship to dose. Most bleedings, 85.2% (n = 23/27), occurred with doses in the standard dose group (≥ 0.95 mg/kg). Thrombosis occurred in 5 patients (0.6%). Utilization of a reduced weight-based dosing strategy for therapeutic enoxaparin in obese patients may increase the percentage of patients with a therapeutic anti-Xa level.
摘要：
依诺肝素是一种亲水性肥胖药物，对其表观分布体积影响很小。因此,接受1mg/kg标准剂量的肥胖患者接受超治疗剂量的风险较高.相反，减少剂量的肥胖患者可能会使已经处于危险中的患者发生血栓事件的风险更高.对于肥胖患者，依诺肝素治疗的最适当的基于体重的剂量，数据和建议是可变的。特别是那些体重>100kg或体重指数（BMI）≥40kg/m2的人。本系统评价的目的是对这些数据进行全球评估，以推测肥胖患者的最佳剂量建议。对英语语言研究进行了系统的回顾，并通过Pubmed，EMBASE,和Cochrane中央控制试验登记册（CENTRAL）搜索。如果他们报告在BMI≥40kg/m2或体重>100kg的成年患者中使用依诺肝素，并且基于基于体重的剂量或基于体重的剂量达到治疗性抗Xa的患者百分比，则包括研究。产生治疗性抗Xa水平所需的剂量。在基于依诺肝素体重的给药类别（包括极低剂量组：<0.75mg/kg，低剂量组：0.75-0.85mg/kg，标准剂量组：≥0.95mg/kg。还评估了出血和血栓形成的比率。共纳入8项研究。对于反Xa级别评估，包括682名患者。在极低剂量组中，总共有62％的抗Xa水平是治疗性的，低剂量组的66%，标准剂量组为42%。对798例患者的总体出血和血栓形成率进行了评估。共发生29次出血(3.6%),27报告了与剂量的关系。大多数出血，85.2%(n=23/27)，标准剂量组（≥0.95mg/kg）的剂量发生。5例患者发生血栓（0.6%）。在肥胖患者中使用基于降低体重的给药策略用于治疗性依诺肝素可能会增加具有治疗性抗Xa水平的患者的百分比。
