{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T05:16:59Z","timestamp":1788671819665,"version":"build-2803163510"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accp1.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Clinical Pharma"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The standard dose of enoxaparin for therapeutic anticoagulation is 1 mg\/kg every 12 h in patients with a creatinine clearance (CrCl) greater than 30 mL\/min. Besides pregnancy, obesity, and renal impairment, literature on other risk factors for supratherapeutic anti\u2010Xa levels is sparse. The objective of this retrospective study was to determine novel risk factors for supratherapeutic anti\u2010Xa levels and further inform empiric enoxaparin dosing. We included adult patients with CrCl greater than 30 mL\/min that received 1 \u00b1 0.09 mg\/kg of enoxaparin every 12 h. The primary outcome was the correlation between blood urea nitrogen (BUN) and anti\u2010Xa levels. The associations between other clinical factors and supratherapeutic anti\u2010Xa levels were also evaluated. Secondary outcomes included the incidence of major bleeding and breakthrough thrombosis in patients who had supratherapeutic levels versus those who did not. A total of 732 patients were included in the final analysis. A small correlation was detected between BUN and anti\u2010Xa levels (Pearson correlation coefficient 0.25, <jats:italic>P<\/jats:italic> &lt;. 001). However, multivariate analyses revealed that only female sex, body mass index, number of enoxaparin doses prior to the initial anti\u2010Xa level, concomitant corticosteroid administration, and lower CrCl were associated with an increased risk of supratherapeutic levels (<jats:italic>P<\/jats:italic> &lt;. 05) when controlling for other factors. There were no significant differences in the incidence of major bleeding or breakthrough thrombosis in patients with supratherapeutic, therapeutic, or subtherapeutic levels. In this study, we identified potential risk factors for supratherapeutic anti\u2010Xa levels in patients without severe renal impairment that may be clinically relevant when empirically dosing therapeutic enoxaparin.<\/jats:p>","DOI":"10.1002\/jcph.70023","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T12:05:37Z","timestamp":1743595537000},"page":"1087-1095","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of Risk Factors for Supratherapeutic Anti\u2010Xa Levels With Treatment\u2010Dose Enoxaparin in Hospitalized Patients Without Severe Renal Impairment"],"prefix":"10.1002","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5830-1477","authenticated-orcid":false,"given":"Donna","family":"Barakeh","sequence":"first","affiliation":[{"name":"Department of Pharmacy Houston Methodist Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3119-5088","authenticated-orcid":false,"given":"Michael","family":"Sirimaturos","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsie","family":"Rizk","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist Hospital  Houston TX USA"},{"name":"Department of Surgery Houston Methodist Hospital  Houston TX USA"},{"name":"Houston Methodist Research Institute  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hangil","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Tufts Medical Center  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Sabawi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.3_suppl.188S"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-015-1315-2"},{"issue":"6","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"417","DOI":"10.3949\/ccjm.86a.18029","article-title":"Anti\u2010Xa assays: What is their role today in antithrombotic therapy?","volume":"86","author":"Centeno EH","year":"2019","journal-title":"Cleve Clin J Med"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1L194"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.1_suppl.64S"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2291"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.12240"},{"issue":"1","key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.24926\/iip.v14i1.5174","article-title":"Optimal dosing of enoxaparin in critically ill patients with venous thromboembolism","volume":"14","author":"Abdulla A","year":"2023","journal-title":"Innov Pharm"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2021.06.028"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2005.01204.x"},{"key":"e_1_2_10_12_1","unstructured":"Sanofi. 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