PMID- 25534987
OWN - NLM
STAT- MEDLINE
DCOM- 20150915
LR  - 20181202
IS  - 1557-8615 (Electronic)
IS  - 0883-9441 (Linking)
VI  - 30
IP  - 2
DP  - 2015 Apr
TI  - Unfractionated heparin dosing for therapeutic anticoagulation in critically ill 
      obese adults.
PG  - 395-9
LID - S0883-9441(14)00486-9 [pii]
LID - 10.1016/j.jcrc.2014.11.020 [doi]
AB  - PURPOSE: Research evaluating unfractionated heparin (UFH) dosing in obese 
      critically ill populations is limited. This study aimed to determine optimal 
      weight-based and total therapeutic infusion rates of UFH in this population. 
      METHODS: This retrospective cohort study compared adults on UFH infusions in 
      intensive care units from May 2011 through October 2013 across 3 weight strata: 
      95 to 104 kg (control), 105 to 129 kg (high weight), and greater than or equal to 
      130 kg (higher weight). Primary outcomes included total and weight-based infusion 
      rates for therapeutic anticoagulation. RESULTS: To achieve therapeutic activated 
      partial thromboplastin times, higher weight patients had higher mean infusion 
      rates compared with control (2017 vs 1582 U/h; P = .002). Mean weight-based 
      therapeutic infusion rate was lower in the higher weight group compared with 
      control (13.1 vs 15.8 U kg(-1) h(-1); P = .008). Post hoc analyses indicated mean 
      weight-based infusion rate to achieve therapeutic anticoagulation was 15 U kg(-1) 
      h(-1) in patients less than 165 kg and 13 U kg(-1) h(-1) in patients greater than 
      165 kg. CONCLUSIONS: Patients greater than or equal to 130 kg have lower 
      weight-based heparin requirements compared with patients 95 to 104 kg. This 
      difference appears to be driven by patients greater than 165 kg. Patients greater 
      than 165 kg have lower weight-based heparin requirements, whereas patients from 
      105 to 164 kg have weight-based requirements similar to a normal-weight patient 
      population. Initiating heparin at appropriate weight-based doses for obese 
      patients may optimize anticoagulation.
CI  - Copyright (c) 2014 Elsevier Inc. All rights reserved.
FAU - Hohner, E M
AU  - Hohner EM
AD  - Department of Pharmacy, The Johns Hopkins Hospital, 600 N Wolfe St, Carnegie 180, 
      Baltimore, MD 21287, USA. Electronic address: ehohner1@jhmi.edu.
FAU - Kruer, R M
AU  - Kruer RM
AD  - Department of Pharmacy, The Johns Hopkins Hospital, 600 N Wolfe St, Carnegie 180, 
      Baltimore, MD 21287, USA.
FAU - Gilmore, V T
AU  - Gilmore VT
AD  - Department of Pharmacy, The Johns Hopkins Hospital, 600 N Wolfe St, Carnegie 180, 
      Baltimore, MD 21287, USA.
FAU - Streiff, M
AU  - Streiff M
AD  - Department of Medicine, Division of Hematology, Johns Hopkins Medical 
      Institutions, 600 N Wolfe St, #800, Baltimore, MD 21287, USA.
FAU - Gibbs, H
AU  - Gibbs H
AD  - Department of Pharmacy, The Johns Hopkins Hospital, 600 N Wolfe St, Carnegie 180, 
      Baltimore, MD 21287, USA.
LA  - eng
PT  - Journal Article
DEP - 20141203
PL  - United States
TA  - J Crit Care
JT  - Journal of critical care
JID - 8610642
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anticoagulants/*administration & dosage
MH  - Atrial Fibrillation/complications/*drug therapy
MH  - Cohort Studies
MH  - Comorbidity
MH  - Critical Illness
MH  - Female
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - Infusions, Intravenous
MH  - Intensive Care Units
MH  - Male
MH  - Middle Aged
MH  - Obesity/*complications
MH  - Partial Thromboplastin Time
MH  - Pulmonary Embolism/complications/*drug therapy
MH  - Retrospective Studies
MH  - Time Factors
MH  - Venous Thromboembolism/complications/*drug therapy
OTO - NOTNLM
OT  - Anticoagulation
OT  - Critically ill
OT  - Heparin
OT  - Obesity
EDAT- 2014/12/24 06:00
MHDA- 2015/09/16 06:00
CRDT- 2014/12/24 06:00
PHST- 2014/08/10 00:00 [received]
PHST- 2014/10/27 00:00 [revised]
PHST- 2014/11/26 00:00 [accepted]
PHST- 2014/12/24 06:00 [entrez]
PHST- 2014/12/24 06:00 [pubmed]
PHST- 2015/09/16 06:00 [medline]
AID - S0883-9441(14)00486-9 [pii]
AID - 10.1016/j.jcrc.2014.11.020 [doi]
PST - ppublish
SO  - J Crit Care. 2015 Apr;30(2):395-9. doi: 10.1016/j.jcrc.2014.11.020. Epub 2014 Dec 
      3.