Weight-Based versus Fixed-Dose Enoxaparin Prophylaxis - Cesarean Delivery

A new study published in Obstetrics and Gynecology evaluated fixed-dose versus weight-based enoxaparin dosing in optimizing the anti-Xa levels post-cesarean delivery.

This study included 146 individuals eligible for enoxaparin thromboprophylaxis after cesarean delivery between June 2020 to November 2021. Participants were randomly categorized into a fixed-dose group – receiving 40 mg daily for BMI <40 or 40 mg every 12 hours for BMI ≥40 or higher, and a weight-based group – receiving 0.5 mg/kg every 12 hours enoxaparin dosing. The therapy was initiated during hospitalization and continued for 14 days post-discharge. 

The results showed that the weight-based dosing group had a higher propensity for achieving prophylactic anti-Xa levels than the fixed-dosing group. Sub prophylactic levels were more common in the fixed-dosing group, whereas supra prophylactic levels were only marginally affected by the dose administered. 

Postoperatively, 52% among the weight-based dosing group and 15% among the fixed-dosing group achieved prophylactic peak anti-Xa levels. No event of venous thromboembolism (VTE) was reported in either group. However, 7% of the participants sustained wound complications with weight-based enoxaparin, which occurred only in 1% of individuals in the fixed-dosing group. 

Hence, weight-based enoxaparin dosing showed greater efficacy than the fixed dosing for attaining prophylactic peak anti-Xa levels after cesarean delivery.

Source: Obstetrics & Gynecology. 2022; 140(4). Doi: 10.1097/AOG.0000000000004937