A review was conducted of English-language publications with information related to dosing and outcomes for obese patients receiving any of the 4 LMW heparins marketed in Canada. MEDLINE, PubMed, CINAHL (the Cumulative Index to Nursing and Allied Health Literature), and Interna­tional Pharmaceutical Abstracts (IPA) were searched with the following search terms: “low molecular weight heparin”, “acute coronary syndrome”, “orthopedics”, “venous thromboem­bolism”, and “obesity”. All terms were searched separately and in combination with “warfarin”. Authors of identified articles were not contacted to determine availability of other unpublished data. The review focused on clinical and pharma- cokinetic studies of each of the 4 agents, administered at therapeutic treatment doses for venous thromboembolism, acute coronary syndromes, or other indications in obese patients. Studies involving prophylactic doses of LMW heparins were excluded.

Pharmacokinetic Studies with LMW Heparins in Obesity

Most of the reports of the pharmacokinetics and pharma- codynamics of LMW heparins in obesity are from open-label studies involving a very limited number of otherwise healthy volunteers (Table 2). Anti-Xa levels were used extensively as a measure of efficacy, and the results did not differ significantly between obese and nonobese patients receiving doses according to total body weight. These findings suggest that excess drug accumulation did not occur in these obese volunteers. Apcalis Oral Jelly

tab 2

One pharmacokinetic study of weight-adjusted dosing of nadroparin was identified, but it was excluded from this review because it addressed prophylaxis only.