Individual research recommendation details

Recommendation ID

NG89/2

Question

Dose strategies for people who are obese:- What is the clinical and cost effectiveness of weight-based dose-adjustment strategies of lowmolecular-weight heparin (LMWH) compared with fixed-dose strategies of LMWH for preventing VTE in people who are very obese (BMI over 35) who are admitted to hospital or having day procedures (including surgery and chemotherapy)?

Any explanatory notes
(if applicable)

Why this is important:- Obesity is on the rise in England. The prevalence of obesity increased by 11% between 1993 and 2014 (15% in 1993 and 26% in 2014), which has resulted in more obese people being admitted to hospital. Obesity may as much as double a person's risk of developing hospital-acquired VTE,
therefore most obese people will need prophylaxis. There is much uncertainty about what dose to use and the clinical and cost effectiveness of using weight-based dose-adjustment versus fixeddose
strategies. In current practice, a higher than usual dose is given but this may not be necessary, especially if the person has obesity-related liver disease. Several studies have reported effectiveness in terms of biological measures rather than clinical outcomes such as deep vein thrombosis (DVT) and bleeding events. It is important that there is a clearer understanding of the effects that different dose strategies can have in terms of clinical outcomes. This is because they can directly influence the quality of life of obese people admitted to hospital and help inform clinical decisions on patient care.

Source guidance details

Comes from guidance

Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism

Number

NG89

Date issued

March 2018

Other details