PMID- 31623539
OWN - NLM
STAT- MEDLINE
DCOM- 20200820
LR  - 20200820
IS  - 1477-0377 (Electronic)
IS  - 1358-863X (Linking)
VI  - 25
IP  - 1
DP  - 2020 Feb
TI  - Unfractionated heparin infusion for treatment of venous thromboembolism based on 
      actual body weight without dose capping.
PG  - 47-54
LID - 10.1177/1358863X19875813 [doi]
AB  - Controversy exists regarding the use of dose capping of weight-based 
      unfractionated heparin (UFH) infusions in obese and morbidly obese patients. The 
      primary objective of this study was to compare time to first therapeutic 
      activated partial thromboplastin time (aPTT) in hospitalized patients receiving 
      UFH for acute venous thromboembolism (VTE) among three body mass index (BMI) 
      cohorts: non-obese (< 30 kg/m(2)), obese (30-39.9 kg/m(2)), and morbidly obese (⩾ 
      40 kg/m(2)). In this single-center, retrospective cohort study, patients were 
      included if they ⩾ 18 years of age, had a documented VTE, and were on an infusion 
      of UFH for at least 24 hours. Weight-based UFH doses were calculated using actual 
      body weight. A total of 423 patients met the inclusion criteria, with 230 
      (54.4%), 146 (34.5%), and 47 (11.1%) patients in the non-obese, obese, and 
      morbidly obese cohorts, respectively. Median times to therapeutic aPTT were 16.4, 
      16.6, and 17.1 hours in each cohort. Within 24 hours, the cumulative incidence 
      rates for therapeutic aPTT were 70.7% for the non-obese group, 69.9% for the 
      obese group, and 61.7% for the morbidly obese group (obese vs non-obese: HR = 
      1.02, 95% CI: 0.82-1.26, p = 0.88; morbidly obese vs non-obese: HR = 0.87, 95% 
      CI: 0.62-1.21, p = 0.41). There was no significant difference in major bleeding 
      events between BMI groups (obese vs non-obese, p = 0.91; morbidly obese vs 
      non-obese, p = 0.98). Based on our study, heparin dosing based on actual body 
      weight without a dose cap is safe and effective.
FAU - Shlensky, Julia A
AU  - Shlensky JA
AUID- ORCID: 0000-0001-5902-5577
AD  - Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA.
FAU - Thurber, Kristina M
AU  - Thurber KM
AD  - Department of Pharmacy, Mayo Clinic, College of Medicine, Rochester, MN, USA.
FAU - O'Meara, John G
AU  - O'Meara JG
AD  - Department of Pharmacy, Mayo Clinic, College of Medicine, Rochester, MN, USA.
FAU - Ou, Narith N
AU  - Ou NN
AD  - Department of Pharmacy, Mayo Clinic, College of Medicine, Rochester, MN, USA.
FAU - Osborn, Jennifer L
AU  - Osborn JL
AD  - Department of Pharmacy, Mayo Clinic, College of Medicine, Rochester, MN, USA.
FAU - Dierkhising, Ross A
AU  - Dierkhising RA
AD  - Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, 
      USA.
FAU - Mara, Kristin C
AU  - Mara KC
AD  - Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, 
      USA.
FAU - Bierle, Dennis M
AU  - Bierle DM
AUID- ORCID: 0000-0003-3337-5645
AD  - Department of Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA.
FAU - Daniels, Paul R
AU  - Daniels PR
AD  - Department of Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20191018
PL  - England
TA  - Vasc Med
JT  - Vascular medicine (London, England)
JID - 9610930
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Blood Coagulation/*drug effects
MH  - Body Mass Index
MH  - *Body Weight
MH  - *Drug Dosage Calculations
MH  - Drug Monitoring
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Hospitalization
MH  - Humans
MH  - Infusions, Parenteral
MH  - Male
MH  - Middle Aged
MH  - Obesity/*complications/diagnosis
MH  - Obesity, Morbid/complications
MH  - Partial Thromboplastin Time
MH  - Retrospective Studies
MH  - Venous Thromboembolism/blood/complications/diagnosis/*drug therapy
OTO - NOTNLM
OT  - anticoagulation
OT  - obesity
OT  - unfractionated heparin (UFH)
OT  - venous thromboembolism (VTE)
EDAT- 2019/10/19 06:00
MHDA- 2020/08/21 06:00
CRDT- 2019/10/19 06:00
PHST- 2019/10/19 06:00 [pubmed]
PHST- 2020/08/21 06:00 [medline]
PHST- 2019/10/19 06:00 [entrez]
AID - 10.1177/1358863X19875813 [doi]
PST - ppublish
SO  - Vasc Med. 2020 Feb;25(1):47-54. doi: 10.1177/1358863X19875813. Epub 2019 Oct 18.