PMID- 23404940
OWN - NLM
STAT- MEDLINE
DCOM- 20140422
LR  - 20130930
IS  - 1930-739X (Electronic)
IS  - 1930-7381 (Linking)
VI  - 21
IP  - 9
DP  - 2013 Sep
TI  - Delayed efficient anticoagulation with heparin in patients with a weight of 110 
      kg and more treated for acute coronary syndrome.
PG  - 1753-8
LID - 10.1002/oby.20029 [doi]
AB  - OBJECTIVE: The use of a weight-based nomogram is considered as standard care for 
      prescribing appropriate doses of unfractionated heparin (UFH). Because of the 
      need for multiple other medications that may affect bleeding and that clinical 
      data have relied on similar dosing algorithms, maximum initial bolus and infusion 
      rates have been suggested (capped initial dose). Whether these weight-based 
      heparin nomograms properly address therapeutic dosing in obese patients remains 
      questionable. DESIGN AND METHODS: Thirty patients treated for acute coronary 
      syndrome and weighing >/=110 kg were retrospectively compared with 90 controls 
      (three groups of 30 patients, weighting 50-69.9, 70-89.9, or 90-109.9 kg), all 
      treated with UFH, July 2008 to April 2009. The primary end point was the time 
      required to obtain a threshold activated partial thromboplastin time (aPTT). 
      RESULTS: Mean time to achieve threshold aPTT was longer for obese patients 
      weighing >/=110 kg than for controls (31.47 vs. 12.89 hours; P < 0.0001). At 24 
      hours, 63% of obese patients weighing >/=110 kg had not reached threshold aPTT vs. 
      7% of controls (P < 0.0001). However, threshold infusion rate did not differ 
      between weight categories (13.0 vs. 13.1 U/kg/h; P = NS) and approximated the 
      initial infusion rate recommended by nomograms without applying the dose cap (12 
      U/kg/h). CONCLUSIONS: Adequate anticoagulation time doubled in patients weighing 
      >/=110 kg, suggesting that these patients were not receiving appropriate heparin 
      doses initially to achieve threshold aPTT rapidly. Using initial infusion rate 
      recommended by a nomogram without capping for total body weight is suggested as 
      acceptable in this study. This approach should be further evaluated in a 
      prospective study.
CI  - Copyright (c) 2012 The Obesity Society.
FAU - Joncas, Sebastien X
AU  - Joncas SX
AD  - Faculte de Medecine, Universite de Sherbrooke, Sherbrooke, Canada.
FAU - Poirier, Paul
AU  - Poirier P
FAU - Ardilouze, Jean-Luc
AU  - Ardilouze JL
FAU - Carrier, Nathalie
AU  - Carrier N
FAU - Fayad, Tania
AU  - Fayad T
FAU - Farand, Paul
AU  - Farand P
LA  - eng
PT  - Journal Article
DEP - 20130409
PL  - United States
TA  - Obesity (Silver Spring)
JT  - Obesity (Silver Spring, Md.)
JID - 101264860
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Coronary Syndrome/complications/*drug therapy
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage/pharmacology/therapeutic use
MH  - Blood Coagulation/*drug effects
MH  - *Body Weight
MH  - Case-Control Studies
MH  - Female
MH  - Heparin/*administration & dosage/pharmacology/therapeutic use
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Obesity/*complications
MH  - Partial Thromboplastin Time
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2013/02/14 06:00
MHDA- 2014/04/23 06:00
CRDT- 2013/02/14 06:00
PHST- 2011/04/17 00:00 [received]
PHST- 2012/07/03 00:00 [accepted]
PHST- 2013/02/14 06:00 [entrez]
PHST- 2013/02/14 06:00 [pubmed]
PHST- 2014/04/23 06:00 [medline]
AID - 10.1002/oby.20029 [doi]
PST - ppublish
SO  - Obesity (Silver Spring). 2013 Sep;21(9):1753-8. doi: 10.1002/oby.20029. Epub 2013 
      Apr 9.