PMID- 20587743
OWN - NLM
STAT- MEDLINE
DCOM- 20101008
LR  - 20101222
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 44
IP  - 7-8
DP  - 2010 Jul-Aug
TI  - Identifying optimal initial infusion rates for unfractionated heparin in morbidly 
      obese patients.
PG  - 1141-51
LID - 10.1345/aph.1P088 [doi]
AB  - BACKGROUND: Most literature available for unfractionated heparin (UFH) supports 
      the use of actual body weight for dosing all patients, yet a small proportion of 
      the patients in these studies were morbidly obese. The most appropriate dosing 
      strategy for therapeutic UFH in this patient population is not clearly defined. 
      OBJECTIVE: To better define appropriate UFH dosing strategies in morbidly obese 
      patients and to evaluate the safety of a weight-based heparin nomogram in this 
      patient population. METHODS: Patients with class III (morbid) obesity receiving 
      therapeutic doses of a UFH infusion for greater than 24 hours were evaluated. Two 
      comparator groups of overweight/class I -II obesity and normal/underweight 
      patients were created by matching patients to the class III obesity group. Doses 
      and times to therapeutic activated partial thromboplastin time (aPTT), bleeding 
      rates, and mortality were assessed. RESULTS: The mean infusion rate required to 
      obtain a first therapeutic aPTT was 11.5 units/kg/h in the class III obesity 
      group (n = 94) versus 12.5 units/kg/h and 13.5 units/kg/h for the 
      overweight/class I-II obesity (n = 92) and normal/underweight (n = 87) groups, 
      respectively (p = 0.001). The mean times to a first therapeutic aPTT were 21.3, 
      22.1, and 29.9 hours, respectively (p = 0.421). There was a statistically 
      significant difference in the infusion rate required to obtain 2 consecutive 
      therapeutic aPTTs between groups (p = 0.016), with higher weight groups requiring 
      smaller (per kilogram actual body weight) infusion rates, but there was no 
      significant difference in the time to reach 2 consecutive therapeutic aPTTs (p = 
      0.776). There was no significant difference in bleeding (p = 0.517) or mortality 
      (p = 0.475) among groups. CONCLUSIONS: Morbidly obese patients require smaller 
      UFH infusion rates per kilogram actual body weight compared to patients with 
      lower body mass indices. UFH dosing recommendations should be modified to reflect 
      body mass index classification.
FAU - Riney, Jennifer N
AU  - Riney JN
AD  - Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO 63110, USA. 
      jnr0905@bjc.org
FAU - Hollands, James M
AU  - Hollands JM
FAU - Smith, Jennifer R
AU  - Smith JR
FAU - Deal, Eli N
AU  - Deal EN
LA  - eng
PT  - Controlled Clinical Trial
PT  - Journal Article
DEP - 20100629
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Ann Pharmacother. 2010 Dec;44(12):2037-8; author reply 2038-9. PMID: 21098747
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Body Weight
MH  - Cohort Studies
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Nomograms
MH  - Obesity/*complications/mortality
MH  - Obesity, Morbid/*complications/mortality
MH  - Partial Thromboplastin Time
MH  - Prospective Studies
EDAT- 2010/07/01 06:00
MHDA- 2010/10/12 06:00
CRDT- 2010/07/01 06:00
PHST- 2010/07/01 06:00 [entrez]
PHST- 2010/07/01 06:00 [pubmed]
PHST- 2010/10/12 06:00 [medline]
AID - aph.1P088 [pii]
AID - 10.1345/aph.1P088 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2010 Jul-Aug;44(7-8):1141-51. doi: 10.1345/aph.1P088. Epub 2010 
      Jun 29.