RCT Results: Weight-Based vs Fixed Dosing for Enoxaparin Thromboprophylaxis After Cesarean
BACKGROUND AND PURPOSE:
A fixed dose of 40 mg/day of prophylactic enoxaparin is recommended to achieve inhibition of factor Xa after cesarean delivery
Bruno et al. (Obstetrics & Gynecology, 2022) compared enoxaparin dosing based on patient weight vs fixed dose
Randomized controlled trial
Individuals who met institutional criteria for enoxaparin thromboprophylaxis after cesarean delivery
Fixed enoxaparin dosing
BMI <40: 40 mg daily
BMI ≥40: 40 mg every 12 hours
Weight-based enoxaparin dosing
0.5 mg/kg every 12 hours
Enoxaparin started during inpatient hospitalization | Continued at discharge for 14 days
Sample size: 80% power to detect an 18% difference in the proportion of individuals with prophylactic anti-Xa levels with weight-based compared with fixed enoxaparin dosing | Two-sided type I error rate of 5% | 121 individuals per group were required for the study | Allowing for 10% loss to follow-up, would require 266 individuals in total
Primary analyses: Followed intention-to-treat principle with worst-case imputation for missing outcomes
Secondary analyses: Complete case
Prophylactic (0.2 to 0.6 IU/mL) peak anti-Xa level 4 to 6 hours after at least the third enoxaparin dose
Subprophylactic and supraprophylactic peaks
Venous thromboembolism (VTE)
Wound complications in the first 6 weeks postpartum
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