Comparison of standard versus adjusted dose of enoxaparin for venous thromboembolism prophylaxis in patients with obesity and cancer.

IntroductionActive cancer and body mass index (BMI) greater than 30 kg/m have been shown to increase venous thromboembolism (VTE) risk in hospitalized patients. Optimal dosing strategies in this population remain uncertain. This study evaluated the incidence of healthcare associated VTE (HA-VTE) in patients with active malignancy and obesity, comparing adjusted versus standard dose enoxaparin for VTE prophylaxis.MethodsThis multicenter, retrospective, cohort study compared enoxaparin 40 mg subcutaneously (SC) daily with adjusted enoxaparin dosing (> 40 mg SC daily) for VTE prophylaxis in hospitalized adult patients with a BMI greater than 30 kg/m who received cancer therapy between January 1, 2020, and August 17, 2023. The primary outcome was incidence of HA-VTE. Secondary outcomes included VTE type and bleeding events. Descriptive statistics were used for all outcomes.ResultsA total of 330 patients were included, with a median BMI of 33.7 kg/m² (IQR 31.6-37.9 kg/m²). Standard dose enoxaparin was administered to 300 patients, while 30 received adjusted doses. HA-VTE occurred in 13 patients in the standard dose group, with no HA-VTE events in the adjusted group (p = 0.245). In the standard dose group, 4 patients had minor bleeds, and 2 had clinically relevant non-major bleeds. One minor bleed occurred in the adjusted group (p = 0.490).ConclusionsHA-VTE was more frequent in the standard dosing group, though the small sample size limits the clinical significance. Patients on adjusted doses did not have increased bleeding events. Further research is needed to determine optimal thromboprophylaxis strategies for cancer patients with a BMI over 30 kg/m².