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.

依诺肝素是一种亲水性药物，肥胖对其表观分布容积影响不大，因此接受标准 1 mg/kg 剂量的肥胖患者可能面临更高的超治疗剂量风险。相反，减少肥胖患者的剂量可能会使已经处于危险中的患者面临更高的血栓事件风险。对于肥胖患者，尤其是体重 > 100 kg 或体重指数 (BMI) ≥ 40 kg/m 2 的患者，最合适的基于体重的依诺肝素治疗剂量的数据和建议各不^相同。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回顾，并通过 Pubmed、EMBASE 和 Cochrane 对照试验中央注册库 (CENTRAL) 检索确定了文章。如果研究报告在 BMI ≥ 40 kg/m ²或体重 > 100 kg 的成年患者中使用治疗性依诺肝素，以及基于体重的剂量或基于体重的达到治疗性抗 Xa 的患者百分比，则纳入研究。产生治疗性抗 Xa 水平所需的剂量。抗 Xa 水平的治疗达到情况根据依诺肝素体重剂量类别进行评估，包括极低剂量组：< 0.75 mg/kg、低剂量组：0.75–0.85 mg/kg 和标准剂量组：≥ 0.95 mg/kg 。还评估了出血和血栓形成率。总共纳入了八项研究。对于抗 Xa 水平评估，纳入了 682 名患者。极低剂量组中总共 62% 的抗 Xa 水平具有治疗作用，低剂量组中为 66%，标准剂量组中为 42%。对 798 名患者的总出血率和血栓形成率进行了评估。总共发生 29 例出血（3.6%），其中 27 例报告与剂量有关。大多数出血，85.2% ( n  = 23/27)，发生在标准剂量组 (≥ 0.95 mg/kg) 的剂量下。5 名患者（0.6%）发生血栓。在肥胖患者中采用基于体重的减少剂量策略来治疗依诺肝素可能会增加具有治疗性抗 Xa 水平的患者百分比。