Effectiveness of estimated blood volume-guided prophylactic enoxaparin dosing in patients following minimally invasive surgery.

Authors

Laken Anderson, Tammy Kindel, William J Peppard, Lisa Rein

Published in

Surgery. Pages 110646. Sep 11, 2026. Epub Sep 11, 2026.

Abstract

Enoxaparin is commonly used for venous thromboembolism prophylaxis in surgical patients. Whether body mass index or estimated blood volume-based dosing better achieves target anti-factor Xa levels remains unclear. We compared body mass index and estimated blood volume-based dosing for accuracy in achieving target anti-factor Xa levels.
Patients underwent primary or revisional minimally invasive surgery from January 2015 to June 2024. Inclusion required an anti-factor Xa drawn 2.5-6 hours after 3 consecutive enoxaparin doses. The target range for anti-factor Xa draw was 0.2-0.5 IU/mL. Enoxaparin was dosed based on estimated blood volume using the following guidelines: estimated blood volume 3-4.9 received 30 mg twice daily, estimated blood volume 5-6.9 received 40 mg twice daily, and estimated blood volume >7 received 60 mg twice daily. The dosage based on body mass index used the following: body mass index 18-40 received 40 mg once daily, body mass index 40-50 received 40 mg twice daily, and body mass index >50 received 60 mg twice daily.
Two hundred eighty-seven patients were included for analysis (137 received body mass index dosing, 150 received estimated blood volume dosing). The mean anti-factor Xa level for the estimated blood volume-dosed cohort was 0.27 compared with 0.36 for the body mass index cohort. Estimated blood volume-based enoxaparin dosing produced less variability of anti-factor Xa values than body mass index-based dosing. Spearman rank correlation coefficient showed that estimated blood volume tracks more closely to anti-factor Xa than body mass index.
Estimated blood volume-based enoxaparin dosing resulted in lower and more consistent anti-factor Xa levels compared with body mass index-based dosing and demonstrated a stronger correlation with anticoagulant exposure. However, subtherapeutic levels were more frequent with estimated blood volume-based dosing, highlighting ongoing challenges in achieving optimal prophylaxis with current dosing strategies.

PMID:
42875264
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.

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