Reduced dosing of enoxaparin for venous thromboembolism in overweight and obese adolescents: a single institution retrospective review

ESSENTIALS: Data is scarce on enoxaparin dosing for obese adolescents with venous thromboembolism (VTE). Overweight and obese adolescents treated with reduced enoxaparin dose (RD) were reviewed. Initial enoxaparin doses calculated using actual body weight may be greater than what is needed. Trials are warranted to evaluate RD enoxaparin for overweight and obese adolescents with VTE. BACKGROUND: The global obesity epidemic has created new challenges, including venous thromboembolisms (VTE) in obese adolescents. The data on whether to reduce the dose of low‐molecular heparin in obese adults is conflicting, and information on adolescent patients is scarce. OBJECTIVES: Our primary goal was to describe dosing, anti‐Xa levels, and outcomes of overweight and obese adolescents who received reduced doses of enoxaparin at the initiation of therapy. The secondary goal was to compare their outcomes to overweight and obese adolescents who received standard 1 mg/kg dosing to determine if future trials for dose reduction are warranted. PATIENTS/METHODS: We performed a retrospective cohort study of overweight and obese patients between the ages of 12 and 18 years old diagnosed with VTE who were treated with reduced dosing (RD) of enoxaparin, comparing their dosing, anti‐Xa levels, and outcomes to overweight and obese adolescents who received standard dosing (SD). RESULTS: RD patients (n=19) achieved therapeutic mean initial anti‐Xa levels that were similar to SD patients (n=11). Of the RD patients, 53% did not require dose adjustments during treatment. Two RD patients had thrombus progression. A total of 25 patients ultimately completed therapy with RD. CONCLUSIONS: Future trials are warranted to evaluate the efficacy and safety of reduced dosing of enoxaparin to treat overweight and obese adolescents with VTE.