PMID- 24404457
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20140109
LR  - 20211021
IS  - 2229-5151 (Print)
IS  - 2231-5004 (Electronic)
IS  - 2229-5151 (Linking)
VI  - 3
IP  - 3
DP  - 2013 Jul
TI  - Comparison of heparin dosing based on actual body weight in non-obese, obese and 
      morbidly obese critically ill patients.
PG  - 195-9
LID - 10.4103/2229-5151.119200 [doi]
AB  - BACKGROUND: Obesity is endemic in the United States and obese patients are at 
      increased risk of thromboembolism but little data are available for dosing 
      unfractionated heparin (UFH). We evaluated the relationship between obesity and 
      UFH efficacy during critical illness by examining UFH infusions in non-obese, 
      obese, and morbidly obese critically ill patients. MATERIALS AND METHODS: 
      Retrospective review of UFH infusions in non-obese, obese, and morbidly obese 
      critically ill patients. Heparin was initiated without a bolus at 16 units/kg/h 
      or 12 units/kg/h in obese and morbidly obese patients. Demographics, UFH 
      dosage/therapy duration, laboratory values, and bleeding events were reviewed for 
      patients receiving UFH for >24 h. Steady state (SS) was defined as the dosage 
      that resulted in three consecutive activated partial thromboplastin times (aPTT) 
      within target range. RESULTS: Sixty-two patients were analyzed including 21 
      non-obese (mean body mass index (BMI) 24.2 +/- 2.3); 21 obese (BMI 34.1 +/- 3.1); and 
      20 morbidly obese (mean BMI 55.3 +/- 13.7). Patients had otherwise similar 
      demographics. Although 92% had at least one therapeutic aPTT, only 55% of 
      patients reached SS. Six patients developed minor bleeding, but no major 
      hemorrhagic complications. The dosing of heparin based on actual body weight 
      (units/kg/h) and time to first therapeutic aPTT was similar between groups, but 
      dose was statistically higher at steady state in the non-obese (16.3 +/- 5.3 
      non-obese, 11.6 +/- 5.5 obese and 11.1 +/- 1.2 obese, P = 0.01) with similar times to 
      steady state. CONCLUSIONS: Dosing of UFH in morbidly obese and obese critically 
      ill patients based on actual body weight and a reduced initial dose was 
      associated with similar time to first therapeutic aPTT and steady state.
FAU - Gerlach, Anthony T
AU  - Gerlach AT
AD  - Department of Pharmacy, Wexner Medical Center at the Ohio State University, USA.
FAU - Folino, Jerilynn
AU  - Folino J
AD  - Department of Pharmacy, Wexner Medical Center at the Ohio State University, USA.
FAU - Morris, Benjamin N
AU  - Morris BN
AD  - Department of Anesthesiology, Wake Forrest University, USA.
FAU - Murphy, Claire V
AU  - Murphy CV
AD  - Department of Pharmacy, Wexner Medical Center at the Ohio State University, USA.
FAU - Stawicki, Stansilaw P
AU  - Stawicki SP
AD  - Department of Surgery, Wexner Medical Center at the Ohio State University, USA.
FAU - Cook, Charles H
AU  - Cook CH
AD  - Department of Surgery, Wexner Medical Center at the Ohio State University, USA.
LA  - eng
PT  - Journal Article
PL  - India
TA  - Int J Crit Illn Inj Sci
JT  - International journal of critical illness and injury science
JID - 101571136
PMC - PMC3883198
OTO - NOTNLM
OT  - Critically ill
OT  - heparin
OT  - obesity
COIS- Conflict of Interest: None declared.
EDAT- 2014/01/10 06:00
MHDA- 2014/01/10 06:01
PMCR- 2013/07/01
CRDT- 2014/01/10 06:00
PHST- 2014/01/10 06:00 [entrez]
PHST- 2014/01/10 06:00 [pubmed]
PHST- 2014/01/10 06:01 [medline]
PHST- 2013/07/01 00:00 [pmc-release]
AID - IJCIIS-3-195 [pii]
AID - 10.4103/2229-5151.119200 [doi]
PST - ppublish
SO  - Int J Crit Illn Inj Sci. 2013 Jul;3(3):195-9. doi: 10.4103/2229-5151.119200.