PMID- 23414664
OWN - NLM
STAT- MEDLINE
DCOM- 20130903
LR  - 20130626
IS  - 1097-6833 (Electronic)
IS  - 0022-3476 (Linking)
VI  - 163
IP  - 1
DP  - 2013 Jul
TI  - Evaluation of weight-based dosing of unfractionated heparin in obese children.
PG  - 150-3
LID - S0022-3476(13)00007-3 [pii]
LID - 10.1016/j.jpeds.2012.12.095 [doi]
AB  - OBJECTIVE: To determine whether pediatric patients with obesity receiving 
      weight-based dosages of unfractionated heparin (UFH) exhibit an enhanced response 
      when dosed by actual body weight compared with nonobese patients as assessed 
      primarily by the frequency of supratherapeutic anticoagulation. Secondary 
      measures included UFH doses associated with therapeutic anticoagulation. STUDY 
      DESIGN: This single-institution retrospective case-matched study included 
      children with and without obesity, matched on a 1:1 basis, who received a 
      weight-based continuous infusion of UFH. Therapeutic monitoring values were 
      defined for activated partial thromboplastin time (aPTT) level (70-101 seconds) 
      and anti-activated factor X (Xa) level (0.35-0.7 U/mL). RESULTS: The study 
      included 50 children. The percentage of patients with supratherapeutic 
      anticoagulation at any point in the study, as measured by either aPTT or anti-Xa 
      level, was similar in the obese and nonobese groups (76% vs 72%; P = 1.0). 
      However, compared with patients without obesity, those with obesity received a 
      lower mean starting dose (17.4 vs 20.2 U/kg/hour; P = .013) and a lower mean 
      maintenance dose (19.1 vs 24.3 U/kg/hour; P = .033) to achieve stable therapeutic 
      monitoring test values. There was no difference in mean initial post-UFH aPTT 
      between the 2 groups, but the mean initial anti-Xa level was higher in the obese 
      group (0.45 vs 0.29 U/mL; P = .045). CONCLUSION: Compared with children without 
      obesity, those with obesity who received actual body weight-based continuous UFH 
      infusions did not exhibit a higher frequency of supratherapeutic anticoagulation, 
      but did require lower dosages to achieve comparable anticoagulation. Our results 
      highlight recognized discrepancies between aPTT and anti-Xa monitoring assays.
CI  - Copyright (c) 2013 Mosby, Inc. All rights reserved.
FAU - Taylor, Breann N
AU  - Taylor BN
AD  - Department of Pharmacy, Texas Children's Hospital, Houston, TX, USA. 
      breann.taylor@cchmc.org
FAU - Bork, Sara J D
AU  - Bork SJ
FAU - Kim, Shelly
AU  - Kim S
FAU - Moffett, Brady S
AU  - Moffett BS
FAU - Yee, Donald L
AU  - Yee DL
LA  - eng
PT  - Journal Article
DEP - 20130212
PL  - United States
TA  - J Pediatr
JT  - The Journal of pediatrics
JID - 0375410
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adolescent
MH  - Anticoagulants/*administration & dosage
MH  - *Body Weight
MH  - Child
MH  - Child, Preschool
MH  - Drug Dosage Calculations
MH  - Female
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - Male
MH  - *Obesity/blood
MH  - Retrospective Studies
EDAT- 2013/02/19 06:00
MHDA- 2013/09/04 06:00
CRDT- 2013/02/19 06:00
PHST- 2012/09/20 00:00 [received]
PHST- 2012/12/10 00:00 [revised]
PHST- 2012/12/28 00:00 [accepted]
PHST- 2013/02/19 06:00 [entrez]
PHST- 2013/02/19 06:00 [pubmed]
PHST- 2013/09/04 06:00 [medline]
AID - S0022-3476(13)00007-3 [pii]
AID - 10.1016/j.jpeds.2012.12.095 [doi]
PST - ppublish
SO  - J Pediatr. 2013 Jul;163(1):150-3. doi: 10.1016/j.jpeds.2012.12.095. Epub 2013 Feb 
      12.