PMID- 25448664
OWN - NLM
STAT- MEDLINE
DCOM- 20150714
LR  - 20181202
IS  - 1743-9159 (Electronic)
IS  - 1743-9159 (Linking)
VI  - 12
IP  - 12
DP  - 2014 Dec
TI  - Weight based heparin dosing for thromboembolic disease is associated with earlier 
      anticoagulation in surgical patients.
PG  - 1416-9
LID - S1743-9191(14)00941-8 [pii]
LID - 10.1016/j.ijsu.2014.10.022 [doi]
AB  - INTRODUCTION: Achievement of early therapeutic anticoagulation with 
      unfractionated heparin (UFH) is associated with improved outcomes in 
      thromboembolic disease. Weight based UFH expedites time to therapeutic 
      anticoagulation. Treatment with UFH is challenging in surgical patients due to 
      their high propensity for bleeding. We sought to test the hypothesis that an 
      initial weight based UFH infusion in surgical patients increases the percentage 
      of patients who achieve early therapeutic anticoagulation without increasing the 
      risk of hemorrhagic events. METHODS: Using a non-concurrent retrospective cohort 
      study design, adult surgical patients receiving UFH for venous thromboembolism 
      (VTE) at a tertiary care center were included. Two groups were identified: the 
      weight based (WB) and the under-dosed (UD) heparin groups. For our primary 
      outcome, we compared percentage of patients in each group that achieved a 
      therapeutic PTT within 24 h. Secondary outcomes included the incidence of 
      supratherapeutic PTT levels, hemorrhagic events, and complications associated 
      with VTE. RESULTS: 73 subjects met study criteria, which included 8 subjects in 
      the WB group and 65 in the UD group. The demographic, baseline laboratory, 
      admitting service and type of VTE were similar between the 2 groups. The 
      percentages of WB and UD subjects who achieved a therapeutic PTT within 24 h were 
      75% and 28%, respectively (p < 0.01). There was no difference in the incidence of 
      supratherapeutic PTT or hemorrhagic events. CONCLUSION: Surgical patients who 
      received an initial weight based UFH infusion achieved earlier therapeutic 
      anticoagulation compared to under-dosed UFH without increasing the occurrence of 
      supratherapeutic PTT levels or hemorrhagic events.
CI  - Copyright (c) 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights 
      reserved.
FAU - Levine, Alexander R
AU  - Levine AR
AD  - Department of Pharmacy, Massachusetts General Hospital, USA. Electronic address: 
      arlevine@partners.org.
FAU - Laliberte, Benjamin
AU  - Laliberte B
AD  - Department of Pharmacy, University of Maryland Medical Center, USA.
FAU - Lin, Hsin
AU  - Lin H
AD  - Department of Pharmacy, Massachusetts General Hospital, USA.
FAU - Stan, Kimberleigh
AU  - Stan K
AD  - Department of Pharmacy, Massachusetts General Hospital, USA.
FAU - Ladha, Karim S
AU  - Ladha KS
AD  - Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General 
      Hospital, USA.
FAU - Kaafarani, Haytham M A
AU  - Kaafarani HM
AD  - Harvard Medical School, Division of Trauma, Emergency Surgery and Surgical 
      Critical Care, Department of Surgery, Massachusetts General Hospital, USA.
FAU - Lee, Jarone
AU  - Lee J
AD  - Harvard Medical School, Division of Trauma, Emergency Surgery and Surgical 
      Critical Care, Department of Surgery, Massachusetts General Hospital, USA.
LA  - eng
PT  - Journal Article
DEP - 20141028
PL  - United States
TA  - Int J Surg
JT  - International journal of surgery (London, England)
JID - 101228232
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - *Body Weight
MH  - Cohort Studies
MH  - *Drug Dosage Calculations
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Heparin, Low-Molecular-Weight
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - *Surgical Procedures, Operative
MH  - Venous Thromboembolism/blood/complications/*drug therapy
OTO - NOTNLM
OT  - Anticoagulants
OT  - Cardiology
OT  - Drug safety
OT  - Heparin
EDAT- 2014/12/03 06:00
MHDA- 2015/07/15 06:00
CRDT- 2014/12/03 06:00
PHST- 2014/05/27 00:00 [received]
PHST- 2014/09/22 00:00 [revised]
PHST- 2014/10/25 00:00 [accepted]
PHST- 2014/12/03 06:00 [entrez]
PHST- 2014/12/03 06:00 [pubmed]
PHST- 2015/07/15 06:00 [medline]
AID - S1743-9191(14)00941-8 [pii]
AID - 10.1016/j.ijsu.2014.10.022 [doi]
PST - ppublish
SO  - Int J Surg. 2014 Dec;12(12):1416-9. doi: 10.1016/j.ijsu.2014.10.022. Epub 2014 
      Oct 28.