A 52-year-old male weighing 240 kg and BMI 74 kg/m2 was admitted to the hospital with a diagnosis of ischemic stroke.
As a pathological history of interest, the patient had deep venous thromboembolism in the past, which is why he was prescribed home anticoagulant therapy with Rivaroxaban.
The possibility of carrying out fibrinolytic treatment with alteplase is raised in the Emergency Department.
However, after the examination, this intervention was disregarded, as the patient was in a borderline state of the temporal interval, presented 23 points on the NIHSS scale the last assessment institute of health strokeb, and was classified as
After admission to the ICU for neurological monitoring and surveillance, it was decided to start treatment with enoxaparin as anticoagulant therapy.
To this end, the Intensive Care Unit contacted the dementia unit in order to know the most appropriate dosage given the situation of extreme obesity2 (BMI > 40 kg/m2).
For safety reasons, given the paucity of data, it was decided to initiate treatment at a dose of 0.7 mg/kg/12 h subcutaneously (enoxaparin 160 mg/12 h) to avoid bleeding, as assessed in several clinical trials.
In addition, anti-Xa factor monitoring was established to establish the final dose.
1.
Four hours after administration of the third dose, the concentration of anti-Xa factor in blood obtained was 0.37 IU/mL.
Between 0.35-0.49 IU/mL we proceeded to increase ≈10% the dose (170 mg/12 h).
Four hours after the next dose, the concentration of anti-Xa factor was 0.59 IU/mL, and at 24 hours, 0.48 IU/mL.
In view of this result, the dose was increased to 180 mg/12 h.
Finally, the following determination obtained a value of 0.84 IU/mL, placing us within the therapeutic range and fixing the optimal dose for our patient at 0.75 mg/kg/12 h.
