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In addition, anti-Factor Xa levels in the FD group were only measured following the first dose of enoxaparin and may not reflect a true steady state. Nevertheless, even if there was a 20% increase in peak anti-Factor Xa levels on dosing Day 2, most patients in the FD may still have had anti-Factor levels below the target range. Enoxaparin accumulation has been reported to occur during longer treatment periods [19] and in patients with moderate to severe renal failure [18] and thus close monitoring may be warranted when weight-based enoxaparin is prescribed for longer periods of time. Finally, we did not study anti-Factor Xa levels in non-obese, medically ill patients and cannot exclude the possibility that non-obese patients would have similar variance in anti-Factor Xa levels. In conclusion, these data demonstrate that enoxaparin 0.5 http://www.selleckchem.com/products/XL184.html mg/kg QDay is superior to either FD enoxaparin 40 mg QDay or a lower weight-based regimen of 0.4 mg/kg QDay for achieving target peak anti-Factor Xa levels in medically ill patients with extreme obesity. This dosing regimen was not associated with adverse clinical events such as bleeding or thrombosis. Eligible patients were hospitalized, medically ill patients �� 18 years of age with extreme obesity (WHO Class Obesity: BMI �� 40 kg/m2) and having ��1 major VTE risk factor, including age > 70, heart failure, acute respiratory failure, previous VTE, cancer, stroke, sepsis, and immobility http://www.selleckchem.com/products/CP-690550.html (defined as ��3 days of bed-rest) [4]. Patients were excluded http://www.selleck.cn/products/MLN8237.html if they were pregnant, on therapeutic anticoagulation, had a bleeding disorder, platelet count of less than 100,000/mL, coagulopathy, active bleeding, estimated creatinine clearance
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