Table 2.
Clinical studies on the use of low-molecular-weight heparin, fondaparinux and unfractionated heparin for venous thromboembolism prophylaxis in obese patients.
| Study, year (n) |
Study design | Population | Obese (%) |
Agent and dose |
Mechanical prophylaxis |
BMI (kg/m2) | Outcomes | Ref. | ||
|---|---|---|---|---|---|---|---|---|---|---|
| VTE/MB | Nonobese | Obese | ||||||||
| Kucher et al., 2005 (3706) | RCT retrospective subgroup analysis | Medically ill | 30 | Dalteparin 5000 U/day | NR | Mean BMI >30 (men); BMI >28 (women) | VTE by day 21 (MB) | 2.8% (95% CI: 1.6%) | 2.8% (95% CI: 0%) | [50] |
| Placebo | 5.2% (95% CI: 0.3%) | 4.3% (95% CI: 0.7%) | ||||||||
| Samama et al., 1995 (817) | Retrospective analysis | Orthopedic surgery | NR | Enoxaparin 40 mg/day | NR | BMI >32 | VTE | 16.7% | 31.8% (p < 0.001) | [37] |
| Scholten et al., 2002 (481) | Prospective cohort | Bariatric surgery | 100 | Enoxaparin 30 mg every 12 h | EA, GCS, IPC | Mean BMI 50–51 | VTE (MB) | 5.4% (95% CI: 1.1%) | [51] | |
| 40 mg every 12 h | 0.6% (95% CI: 0.3%) | |||||||||
| Escalante-Tattersfield et al., 2008 (618) | Retrospective analysis | Bariatric surgery | 100 | Enoxaparin 40 mg every 12 h | EA, IPC, high-risk IVCF | BMI >35 | VTE (MB) | 0.16% (95% CI: 1.6%) | [65] | |
| Magee et al., 2010 (735) | Retrospective cohort | Bariatric Surgery | 100 | Dalteparin 2500 IU preoperatively, 5000 IU daily post-operatively | EA, high-risk IVCF | Symptomatic VTE compared with HC | 0 VTE events at 6 months–11 years, HC: 1.9–3.5% (MB: 0.4%) | [66] | ||
| Agnelli et al., 2005 (2858) | RCT subgroup analysis | High-risk abdominal surgery | 22 | Fondaparinux 2.5 mg s.c. | NR | BMI >30 (men); BMI >28.6 (women) | VTE (MB) | 4.6% (95% CI: 3.4%) | 8.6% (2.9%) | [54] |
| Dalteparin 5000 U/day | 6.1% (95% CI: 2.4%); NS | 6% (95% CI: 2.2%); NS | ||||||||
| Turpie et al., 2002 (5252) | Subgroup analysis | Orthopedic surgery | 25 | Fondaparinux 2.5 mg s.c. q.d. | NR | BMI ≥30 | VTE up to day 11 | 42/628 patients (7.6%) | [53] | |
| Enoxaparin 30 mg b.i.d. or 40 mg q.d. | 102/668 patients (15.3%) | |||||||||
| Shepherd et al., 2004 (19) | Case series | Bariatric surgery, high risk | 100 | UFH low-dose IV infusion, target anti-FXa 0.15–0.2 units/ml | GCS or Ace™ bandage | BMI >35 | Anti-FXa levels, symptomatic VTE (MB) | Average anti-FXa 0.15 U/ml (95% CI: 0.10–0.29); no VTE (two events) | [31] | |
| Shepherd et al., 2003 (700) | Case series | Bariatric surgery | 100 | s.c. UFH, target anti-FXa 0.11–0.25 units/ml | GCS or Ace bandage | BMI >35 | Symptomatic VTE (MB) | 0.4% (1%) | [32] | |
b.i.d.: Twice per day; EA: Early ambulation; FXa: Factor Xa; GCS: Graduated compression stocking; HC: Historical control; HRIVCF: Inferior venous filter placement in high-risk patients; IPC: Intermittent pneumatic compression; IVCF: Inferior vena cava filter; MB: Major bleed; NR: Not reported; NS: Not significant; q.d.: Once daily; RCT: Randomized controlled trial; s.c.: Subcutaneously; U: Units; UFH: Unfractionated heparin; VTE: Venous thromboembolism.
Data taken from [64].