PMID- 28070821
OWN - NLM
STAT- MEDLINE
DCOM- 20170417
LR  - 20191210
IS  - 1573-742X (Electronic)
IS  - 0929-5305 (Linking)
VI  - 43
IP  - 4
DP  - 2017 May
TI  - Evaluation of safety and effectiveness of standardized antifactor Xa-based 
      unfractionated heparin protocols in obese versus non-obese patients.
PG  - 476-483
LID - 10.1007/s11239-016-1466-9 [doi]
AB  - Recent data have suggested that standard unfractionated heparin (UFH) protocols 
      may over-anticoagulate obese patients. The goal of this retrospective study was 
      to observe differences in anticoagulation parameters and safety outcomes for 
      standardized antifactor Xa UFH protocols in obese and non-obese populations. 
      Obese patients (N = 148) were identified over a 20-month period and matched to 
      148 non-obese patients based on age, gender, and admission date. Patients were 
      included if they were on one of three approved UFH protocols [high (target 
      antifactor Xa 0.3-0.7 IU/mL), moderate (0.3-0.5 IU/mL), or low (0.1-0.2 IU/mL) 
      dose] for >/=24 consecutive hours and had >/=1 antifactor Xa level drawn during the 
      infusion. Groups were compared for doses at first and second consecutive 
      therapeutic antifactor Xa level, major bleeding, and in-hospital mortality. Obese 
      patients required a significantly lower mean weight-based infusion rate to attain 
      first therapeutic antifactor Xa level compared to non-obese patients in both the 
      high dose (19.45 vs. 15.29 units/kg/h, p < 0.001) and the moderate dose 
      populations (15.0 vs. 12.94 units/kg/h, p = 0.003). Similarly, patients in both 
      the high and moderate dose populations had significant differences in mean 
      infusion rates to attain second consecutive therapeutic antifactor Xa levels. 
      There was no difference between infusion rates for the primary outcomes in the 
      low dose population. There was no difference between groups in major bleeding or 
      mortality outcomes. Similar to data using UFH protocols based on activated 
      partial thromboplastin time, obese patients require lower weight-based UFH doses 
      to attain therapeutic anticoagulation. Institutions using or changing to 
      antifactor Xa based protocols may need to modify protocols for obese patients.
FAU - Isherwood, Manuel
AU  - Isherwood M
AD  - Philadelphia College of Pharmacy at the University of the Sciences, 600 S 43rd 
      St, Philadelphia, PA, 19104, USA. manuel.isherwood@wilkes.edu.
FAU - Murphy, Michelle L
AU  - Murphy ML
AD  - Cooper University Hospital, 1 Cooper Plaza, Camden, NJ, 08103, USA.
FAU - Bingham, Angela L
AU  - Bingham AL
AD  - Philadelphia College of Pharmacy at the University of the Sciences, 600 S 43rd 
      St, Philadelphia, PA, 19104, USA.
FAU - Siemianowski, Laura A
AU  - Siemianowski LA
AD  - Cooper University Hospital, 1 Cooper Plaza, Camden, NJ, 08103, USA.
FAU - Hunter, Krystal
AU  - Hunter K
AD  - Cooper University Hospital, 1 Cooper Plaza, Camden, NJ, 08103, USA.
FAU - Hollands, James M
AU  - Hollands JM
AD  - Philadelphia College of Pharmacy at the University of the Sciences, 600 S 43rd 
      St, Philadelphia, PA, 19104, USA.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/administration & dosage/pharmacology
MH  - Case-Control Studies
MH  - Dose-Response Relationship, Drug
MH  - Factor Xa Inhibitors/*administration & dosage/pharmacology
MH  - Female
MH  - Hemorrhage
MH  - Heparin/*administration & dosage/pharmacology
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Matched-Pair Analysis
MH  - Middle Aged
MH  - Obesity/*drug therapy
MH  - Patient Safety
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Anticoagulation
OT  - Antifactor Xa
OT  - Body mass index
OT  - Heparin
OT  - Obesity
OT  - Patient safety
EDAT- 2017/01/11 06:00
MHDA- 2017/04/18 06:00
CRDT- 2017/01/11 06:00
PHST- 2017/01/11 06:00 [pubmed]
PHST- 2017/04/18 06:00 [medline]
PHST- 2017/01/11 06:00 [entrez]
AID - 10.1007/s11239-016-1466-9 [pii]
AID - 10.1007/s11239-016-1466-9 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2017 May;43(4):476-483. doi: 10.1007/s11239-016-1466-9.