PMID- 28107569
OWN - NLM
STAT- MEDLINE
DCOM- 20171004
LR  - 20171004
IS  - 1875-9114 (Electronic)
IS  - 0277-0008 (Linking)
VI  - 37
IP  - 4
DP  - 2017 Apr
TI  - Higher Maximum Doses and Infusion Rates Compared with Standard Unfractionated 
      Heparin Therapy Are Associated with Adequate Anticoagulation without Increased 
      Bleeding in Both Obese and Nonobese Patients with Cardiovascular Indications.
PG  - 393-400
LID - 10.1002/phar.1904 [doi]
AB  - STUDY OBJECTIVE: To evaluate the time to achieve therapeutic activated partial 
      thromboplastin time (aPTT) values and occurrence of bleeding based on standard 
      unfractionated heparin (UFH) weight-based dosing recommendations compared with an 
      aggressive weight-based UFH dosing strategy using higher maximum doses and 
      infusion rates in both obese and nonobese patients who presented with 
      non-ST-segment elevation myocardial infarction or unstable angina (NSTEMI/UA) or 
      atrial fibrillation. DESIGN: Retrospective cohort study. SETTING: Academic 
      medical center. PATIENTS: A total of 197 adults were included who were admitted 
      for NSTEMI/UA, atrial fibrillation, or other cardiac indications and received at 
      least 6 hours of a continuous UFH infusion. Of those patients, 71 were treated 
      with standard UFH dosing (60-unit/kg bolus [or maximum 4000 units] followed by an 
      infusion of 12 units/kg/hour [or maximum 1000 units/hr]) between September 2013 
      and February 2014, and 126 patients received an aggressive UFH dosing strategy 
      (60-unit/kg bolus [or maximum 10,000 units] followed by an infusion of 12 
      units/kg/hr [or maximum 2250 units/hr]) between October 2014 and March 2015. 
      Patients in the standard dosing and aggressive strategy cohorts were further 
      classified by body mass index status (normal, overweight, obese, and morbidly 
      obese) and weight status. MEASUREMENTS AND MAIN RESULTS: A time-to-event analysis 
      for achievement of therapeutic aPTT range (60-80 sec) was assessed. A 
      significantly higher proportion of patients treated with the aggressive strategy 
      achieved a therapeutic aPTT within 6 hours (23% vs 11%, p=0.043). The delay or 
      failure to achieve therapeutic anticoagulation was particularly evident in obese 
      patients in the standard dosing group. The mean +/- SD initial infusion rate was 
      10.8 +/- 1.4 units/kg/hour in the standard dosing group versus 12 +/- 0.02 
      units/kg/hour in the aggressive strategy group (p=<0.0005). The occurrence of 
      supratherapeutic aPTT values and the highest aPTT achieved were similar between 
      the two dosing groups (p=0.817 and p=0.348, respectively). No bleeding events 
      were reported in either group. CONCLUSION: Patients who had higher UFH maximum 
      bolus doses and infusion rates achieved therapeutic anticoagulation more rapidly, 
      without increased bleeding, and these doses can be adjusted for obese as well as 
      nonobese patients. However, despite use of the higher doses, only 23% of patients 
      achieved therapeutic aPTT values within 6 hours, suggesting that an even higher 
      bolus dose and infusion rate may still be warranted.
CI  - (c) 2017 Pharmacotherapy Publications, Inc.
FAU - Floroff, Catherine K
AU  - Floroff CK
AD  - Sentara Healthcare, Virginia Beach, Virginia.
FAU - Palm, Nicole M
AU  - Palm NM
AD  - Cleveland Clinic, Cleveland, Ohio.
FAU - Steinberg, Daniel H
AU  - Steinberg DH
AD  - Medical University of South Carolina, Charleston, South Carolina.
FAU - Powers, Eric R
AU  - Powers ER
AD  - Medical University of South Carolina, Charleston, South Carolina.
FAU - Wiggins, Barbara S
AU  - Wiggins BS
AD  - Medical University of South Carolina, Charleston, South Carolina.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20170310
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Academic Medical Centers
MH  - Aged
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Cohort Studies
MH  - Dose-Response Relationship, Drug
MH  - Hemorrhage/*chemically induced/epidemiology
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Infusions, Intravenous
MH  - Middle Aged
MH  - Obesity/*complications
MH  - Obesity, Morbid/complications
MH  - Overweight/complications
MH  - Partial Thromboplastin Time
MH  - Retrospective Studies
MH  - Time Factors
OTO - NOTNLM
OT  - non-ST-segment elevation myocardial infarction
OT  - obesity
OT  - unfractionated heparin
OT  - unstable angina
EDAT- 2017/01/21 06:00
MHDA- 2017/10/05 06:00
CRDT- 2017/01/21 06:00
PHST- 2017/01/21 06:00 [pubmed]
PHST- 2017/10/05 06:00 [medline]
PHST- 2017/01/21 06:00 [entrez]
AID - 10.1002/phar.1904 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2017 Apr;37(4):393-400. doi: 10.1002/phar.1904. Epub 2017 Mar 
      10.