Venous thromboembolism (VTE) is often treated with low molecular weight heparins (LMWH) such as enoxaparin. For patients with normal renal function, dosing is as follows
Enoxaparin: 1 mg/kg subcutaneously every 12 hours, or 1.5 mg/kg every 24 hours
Dalteparin 200 IU/kg subcutaneously once daily
Tinzaparin: 175 IU/kg subcutaneously once daily
What about the obese patient? Is there a maximum dose for enoxaparin?
There is NO maximum enoxaparin dose for treatment of VTE.
Studies have evaluated dosing for patients weighing up to 190 kg and found
the 1 mg/kg q12 hour dosing to be safe and effective. It can even be used for
patients heavier than 190 kg, but anti-Xa monitoring is recommended.
Dosing should be based on total body weight.
In patients with a BMI > 27, use the q12 hour dosing (not q24 hours).
Doses should not be capped for VTE treatment (studies differ on whether or not to cap in treatment of acute coronary syndrome).
In patients > 190 kg, it is recommended to monitor anti-Xa levels if available.
EA, Spinler SA, Wittkowsky A, et al. Low-molecular-weight heparins in renal
impairment and obesity: available evidence and clinical practice recommendations
across medical and surgical settings. Ann Pharmacother
2009;43(6):1064-83. [ PMID 19458109 ]