Dosage Optimization of enoxaparin in the treatment of cardiovascular diseases in Egyptian obese patients

Abstract

Background: Obesity is a growing global health challenge, notably prevalent in Egypt, where it exacerbates cardiovascular risk. Enoxaparin, a low molecular weight heparin, is widely used for anticoagulation, yet standard dosing may not be optimal for obese patients due to altered pharmacokinetics. Limited local data exist on the clinical and economic implications of such dosing discrepancies in critically ill cardiovascular patients. Objective: To assess the impact of obesity on the efficacy, safety, and ECHO (Economic, Clinical, and Humanistic Outcomes) of therapeutic enoxaparin in obese versus lean patients with cardiovascular diseases. Methods: A prospective, observational cohort study was conducted at Badr University Hospital from December 2020 to December 2023. Fifty ICU/CCU patients receiving therapeutic enoxaparin (1 mg/kg SC every 12 hours) were grouped by BMI: obese (≥30 kg/m², n=25) and lean (<30 kg/m², n=25). Peak anti-factor Xa levels were measured 3–5 hours after the third dose. Secondary outcomes included oxygen therapy duration, hospital stay, INR, bleeding events, and total direct cost. Correlation and regression analyses explored predictors of anti-Xa activity. Results: Obese patients had significantly lower anti-Xa levels (0.70 vs. 1.03 IU/mL, p<0.001), more frequent subtherapeutic exposure (32% vs. 0%), longer hospital stay (8.6 vs. 6.8 days), and higher costs (63.8 vs. 50.9 ×10³ LE). BMI was the only independent predictor of anti-Xa levels. Conclusions: Standard enoxaparin dosing may lead to subtherapeutic anticoagulation in obese patients. Individualized dosing and anti-Xa monitoring are recommended to improve efficacy, reduce adverse outcomes, and optimize resource use