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Research Snapshot Theater: Quality and Patient Safety, Adult III

Impact of Pharmacy-Guided Enoxaparin Dosing in Obese Patients in ICU: A Quality Improvement Study

Tuesday, March 24, 2026
12:30 PM - 1:30 PM Central Time
Location: Connections Central - RST 10
Introduction: Enoxaparin dosing in obese patients presents clinical challenges due to altered pharmacokinetics and increased risk of adverse events. This quality improvement project evaluated the impact of pharmacy consultation on enoxaparin management in ICU patients with body mass index (BMI) > 35 kg/m².


Methods: A retrospective review was conducted on 117 adult patients receiving enoxaparin dosed every 12 hours. Patients were divided into two groups based on whether pharmacy was consulted (n = 99) or not (n = 18). The primary outcomes included anti-Xa level attainment and enoxaparin dose adjustment. Secondary outcomes included major bleeding events—defined as intracranial hemorrhage, retroperitoneal bleeding, or a hemoglobin drop requiring transfusion of >2 units of red blood cells—and renal failure (acute or chronic kidney disease as defined by KDIGO criteria).


Results: Baseline characteristics were similar between the pharmacy and non-pharmacy groups, including age (60 ± 15 vs 61 ± 15 years, p = 0.8), weight (128 ± 30 vs 130 ± 40 kg, p = 0.8), and BMI (44 ± 9 vs 44 ± 10 kg/m², p = 1). Enoxaparin dosing per kilogram was also comparable (0.97 ± 0.18 vs 0.92 ± 0.40 mg/kg, p = 0.4). Although not statistically significant, the pharmacy group had higher rates of major bleeding events (23% vs 11%, p = 0.3) and renal failure (40% vs 22%, p = 0.1). Patients in the pharmacy group were significantly more likely to achieve target anti-Xa levels (68% vs 22%, p = 0.0002) and have dose adjustments made based on monitoring (34% vs 0%, p = 0.003).


Conclusions: Pharmacy involvement in enoxaparin management for obese patients with BMI > 35 significantly improved therapeutic monitoring and appropriate dose adjustment. Further prospective studies are needed to assess clinical outcomes and refine dosing strategies in this high-risk population.