Appay Marcelle, Kharadi Shreyas, Nanayakkara Sajani, Ryu Ji Sang, Pasalic Leonardo, Alffenaar Jan-Willem
School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Department of Pharmacy, John Hunter Hospital, Newcastle, NSW, Australia.
Ann Pharmacother. 2025 Mar;59(3):262-276. doi: 10.1177/10600280241256351. Epub 2024 Jun 19.
This review aims to systematically summarize the available data on efficacy and safety of therapeutic enoxaparin in obese patients and to identify gaps to guide future research.
Medline and Embase were systematically searched for eligible studies (last searched December 20, 2023). Studies were included if they reported on therapeutic dosing regimens, adverse bleeding, thrombotic outcomes, or antifactor Xa (AFXa) monitoring in obese adult patients.
The systematic review management tool Covidence was used to manage the study selection and data extraction process. The reference list from eligible studies was screened to determine any additional eligible studies.
Sixteen studies were included in the analysis. Studies used a variety of doses, indications, and study designs making comparison difficult. Twelve studies reported the incidence of thrombotic events (median = 1.3% [interquartile range [IQR] = 0.3%-2.3%]) and all studies reported the incidence of bleeding events (median = 5.7% [IQR = 2.4%-14.5%]). Two of the 8 studies analyzing the influence of weight/body mass index (BMI) or dose per kg on AFXa levels reported statistically significant results. One study concluded that BMI did not affect achievement of target AFXa levels. However, the second study found that dosing using actual body weight was an independent predictor of supratherapeutic AFXa levels in the obese population.
This is the first comprehensive review with a focus on therapeutic dosing of enoxaparin in obesity and has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Seven of the included studies were published since 2018 indicating that new evidence on this topic is emerging.
There was inadequate evidence to support an optimal dosing strategy in obese patients due to the heterogeneity of the studies. The AFXa monitoring may be appropriate to guide dosing in this population. Further research is required to determine a suitable dosing regimen.
本综述旨在系统总结肥胖患者使用治疗性依诺肝素的疗效和安全性的现有数据，并找出差距以指导未来研究。
对Medline和Embase进行系统检索以查找符合条件的研究（最后检索时间为2023年12月20日）。如果研究报告了肥胖成年患者的治疗剂量方案、出血不良反应、血栓形成结局或抗Xa因子（AFXa）监测情况，则纳入该研究。
使用系统综述管理工具Covidence来管理研究选择和数据提取过程。对符合条件的研究的参考文献列表进行筛选，以确定任何其他符合条件的研究。
16项研究纳入分析。各研究使用了多种剂量、适应证和研究设计，难以进行比较。12项研究报告了血栓形成事件的发生率（中位数 = 1.3% [四分位间距[IQR]=0.3%-2.3%]），所有研究均报告了出血事件的发生率（中位数 = 5.7% [IQR = 2.4%-14.5%]）。在分析体重/体重指数（BMI）或每千克剂量对AFXa水平影响的8项研究中，有2项报告了具有统计学意义的结果。一项研究得出结论，BMI不影响AFXa目标水平的达成。然而，第二项研究发现，按实际体重给药是肥胖人群中AFXa水平超治疗范围的独立预测因素。
这是第一项专注于肥胖患者依诺肝素治疗剂量的全面综述，并且是按照系统评价和Meta分析的首选报告项目（PRISMA）2020声明进行的。纳入的研究中有7项自2018年以来发表，表明关于该主题的新证据正在出现。
由于研究的异质性，没有足够证据支持肥胖患者的最佳给药策略。AFXa监测可能适合指导该人群的给药。需要进一步研究以确定合适的给药方案。
