PMID- 15741422
OWN - NLM
STAT- MEDLINE
DCOM- 20050527
LR  - 20061013
IS  - 1060-0280 (Print)
IS  - 1060-0280 (Linking)
VI  - 39
IP  - 4
DP  - 2005 Apr
TI  - Use of a modified dosing weight for heparin therapy in a morbidly obese patient.
PG  - 753-6
AB  - OBJECTIVE: To report a case of successful anticoagulation using a modified dosing 
      weight (DW) for unfractionated heparin (UFH) therapy in a morbidly obese female. 
      CASE SUMMARY: A 54-year-old morbidly obese (182.4 kg, 155 cm) white female 
      presented to the emergency department with tachycardia, shortness of breath, and 
      chest pain, and was diagnosed with a pulmonary embolism. Anticoagulation with UFH 
      was initiated. A modified DW of 120 kg was obtained from the average of the 
      actual body weight (ABW) and ideal body weight ( approximately 50 kg). We 
      selected this modified DW to account for heparin's altered volume of distribution 
      in an obese patient and avoid potentially supratherapeutic activated partial 
      thromboplastin times (aPTTs) using ABW and subtherapeutic aPTTs using DW. Therapy 
      was initiated with a bolus dose of 9600 units (80 units/kg x 120 kg) and 
      continuous infusion rate of 2160 units/h (18 units/kg/h x 120 kg). This infusion 
      rate was maintained throughout the course of heparin therapy and was successful 
      in maintaining therapeutic aPTTs. DISCUSSION: Proper diagnosis and rapid 
      initiation of therapy prevent mortality in patients with PE. Although 
      weight-based heparin nomograms provide standardization through initial bolus and 
      continuous infusion recommendations, many do not address dosing in morbidly obese 
      patients. Several retrospective studies have evaluated actual, dosing, and ideal 
      body weights for heparin therapy in obese patients; however, none has evaluated 
      modified DW. In our patient, successful anticoagulation was objectively 
      confirmed. CONCLUSIONS: Further investigation is necessary to determine the 
      optimal DW for UFH in morbidly obese patients presenting with acute thrombosis.
FAU - Schwiesow, Sarah J
AU  - Schwiesow SJ
AD  - Kaiser Permanente, Englewood, CO 80110-1526, USA. sarah.j.schwiesow@kp.org
FAU - Wessell, Andrea M
AU  - Wessell AM
FAU - Steyer, Terrence E
AU  - Steyer TE
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20050301
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Body Weight/drug effects/*physiology
MH  - Female
MH  - Heparin/*administration & dosage/*blood
MH  - Humans
MH  - Middle Aged
MH  - Obesity, Morbid/*blood
MH  - Pulmonary Embolism/blood/drug therapy
EDAT- 2005/03/03 09:00
MHDA- 2005/05/28 09:00
CRDT- 2005/03/03 09:00
PHST- 2005/03/03 09:00 [pubmed]
PHST- 2005/05/28 09:00 [medline]
PHST- 2005/03/03 09:00 [entrez]
AID - aph.1E300 [pii]
AID - 10.1345/aph.1E300 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2005 Apr;39(4):753-6. doi: 10.1345/aph.1E300. Epub 2005 Mar 1.