Hakeam Hakeam, Alfahed Amjaad, Aldalham Hanin, Mohamed Gamal
Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Ann Pharmacother. 2025 Jul 1:10600280251349582. doi: 10.1177/10600280251349582.
Low body weight is a recognized risk factor for bleeding with standard enoxaparin thromboprophylaxis (40 mg daily). Although reduced enoxaparin doses are used for venous thromboembolism (VTE) prevention in low-weight patients, data on bleeding and VTE outcomes remain limited.
To evaluate rates of bleeding and VTE with the use of fixed dose of enoxaparin 30 mg daily in low-weight surgical patients.Methods:A retrospective, single-center cohort study included low-weight surgical patients who received enoxaparin 30 mg daily from January 2018 to March 2024. The primary outcome was major bleeding within 30 days postoperatively. Secondary outcomes included rates of overall bleeding (major plus clinically relevant nonmajor bleeding) within 30 days and VTE events within 90 days. Risk factors were examined using logistic regression analysis or χ tests.
Data from 129 patients were analyzed. Six (4.7%) patients experienced major bleeding without fatality or bleeding at a critical anatomic site. The overall bleeding rate was 17.1% (n = 22). Five (3.8%) patients developed a VTE, including 2 pulmonary embolism events. Decreasing body weight (odds ratio [OR] = 0.89, 95% confidence interval [CI] = 0.81-0.97, = 0.01), lower preoperative hemoglobin (OR = 0.97, 95% CI = 0.97-0.99, = 0.04), and longer surgery durations (OR = 1.2, 95% CI = 1.05-1.40, = 0.007) were independently associated with an increased risk of developing a bleeding event.
In low-weight surgical patients, thromboprophylaxis with a reduced fixed dose of enoxaparin (30 mg daily) appears safe, with a major bleeding rate below 5%, comparable with rates observed with standard dosing thromboprophylaxis in landmark trials of surgical patients. Among low-weight patients, the lower body weight, preoperative anemia, and prolonged surgical duration were independently associated with increased bleeding risk. These findings highlight the importance of individualized risk assessment when considering a reduced fixed dose of enoxaparin for VTE prevention in low-weight patients undergoing surgery.
低体重是标准依诺肝素血栓预防（每日40毫克）时出血的公认风险因素。尽管在低体重患者中使用降低剂量的依诺肝素预防静脉血栓栓塞（VTE），但关于出血和VTE结局的数据仍然有限。
评估在低体重手术患者中每日使用固定剂量30毫克依诺肝素时的出血和VTE发生率。
一项回顾性单中心队列研究纳入了2018年1月至2024年3月期间每日接受30毫克依诺肝素治疗的低体重手术患者。主要结局是术后30天内的大出血。次要结局包括30天内的总体出血率（大出血加临床相关非大出血）和90天内的VTE事件。使用逻辑回归分析或χ检验检查风险因素。
分析了129例患者的数据。6例（4.7%）患者发生大出血，无死亡或关键解剖部位出血。总体出血率为17.1%（n = 22）。5例（3.8%）患者发生VTE，包括2例肺栓塞事件。体重减轻（优势比[OR]=0.89，95%置信区间[CI]=0.81-0.97，P = 0.01）、术前血红蛋白水平较低（OR = 0.97，95%CI = 0.97-0.99，P = 0.04）和手术时间较长（OR = 1.2，95%CI = 1.05-1.40，P = 0.007）与出血事件发生风险增加独立相关。
在低体重手术患者中，使用降低固定剂量的依诺肝素（每日30毫克）进行血栓预防似乎是安全的，大出血率低于5%，与手术患者标志性试验中标准剂量血栓预防观察到的发生率相当。在低体重患者中，较低的体重、术前贫血和较长的手术时间与出血风险增加独立相关。这些发现凸显了在考虑为接受手术的低体重患者使用降低固定剂量依诺肝素预防VTE时进行个体化风险评估的重要性。
