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A randomized controlled trial of differing doses of postcesarean enoxaparin thromboprophylaxis in obese women

Journal of Perinatology volume 36, pages 95–99 (2016)Cite this article

Subjects

Abstract

Objective:

To compare two enoxaparin dosing strategies at achieving prophylactic anti-Xa levels in women with a body mass index (BMI) ⩾35 (kg m−2) postcesarean delivery.

Study Design:

Women with BMI ⩾35 were randomized to receive prophylactic enoxaparin at a fixed dose of 40 mg daily or weight-based dosing of 0.5 mg kg−1 twice daily. The primary outcome was the proportion of subjects with peak anti-Xa levels in the prophylactic range of 0.2 to 0.6 IU ml−1.

Result:

From August 2013 through February 2014, 84 demographically similar women completed the protocol. In the weight-based group, 88% (37/42) of the women reached prophylactic anti-Xa levels versus 14% (6/42) in the fixed dose group (odds ratio 44.4, 95% confidence interval 12.44, 158.48, P<0.001). No anti-Xa level exceeded 0.48 IU ml−1. There were no venous thromboembolic or bleeding events requiring reoperation or transfusion in either group.

Conclusion:

Compared with fixed dosing daily, weight-based dosing twice daily more effectively achieved prophylactic anti-Xa levels without reaching the therapeutic range.

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Acknowledgements

This study was conducted at the Memorial Care Center for Women at Miller Children’s Hospital, Long Beach Memorial Medical Center, Long Beach, CA 90806, USA and funded by a grant from the Long Beach Memorial Medical Center Foundation.

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Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA

    M L Stephenson, A E Serra & J M Neeper

  2. Department of Obstetrics and Gynecology, Memorial Care Center for Women at Miller Children’s Hospital, Long Beach Memorial Medical Center, Long Beach, CA, USA

    M L Stephenson, A E Serra, J M Neeper, D C Caballero & J McNulty

Authors
  1. M L Stephenson
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  2. A E Serra
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  3. J M Neeper
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  4. D C Caballero
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  5. J McNulty
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Corresponding author

Correspondence to M L Stephenson.

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Competing interests

The authors declare no conflict of interest.

Additional information

Presented at the 35th Annual Meeting of the Society for Maternal Fetal Medicine, San Diego, CA, USA, 2–7 February 2015, Abstract number 26.

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Stephenson, M., Serra, A., Neeper, J. et al. A randomized controlled trial of differing doses of postcesarean enoxaparin thromboprophylaxis in obese women. J Perinatol 36, 95–99 (2016). https://doi.org/10.1038/jp.2015.130

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