Dyslipidemia is highly prevalent in hypertensive adults. Fewer than one third of these adults are drug-treated, and fewer than half of those treated achieve recommended goals. Our findings suggest that an alarming 9 of 10 dyslipidemic hypertensive adults have untreated or undertreated dyslipidemia.

U nfractionated heparin (UFH) is useful for prevention of clot formation or progression of both arterial and venous thromboembolic disorders. A weight-based regimen for determining the dose of UFH has been used for more than 15 years 1 ; however, the effect of this dosing regimen on obese patients is still poorly understood. The volume of distribution of heparin approximates that of the blood volume (40-70 mL/ kg), 2 with obese patients intuitively requiring larger doses of heparin.3 In contrast, the blood volume of adipose tissue is less than that of lean tissue, 2 and thus maximum (dosecapped) initial bolus and initial infusion rates for UFH have been suggested. Although guidelines from the American Effect of Body Mass Index on Bleeding Frequency and Activated Partial Thromboplastin Time in Weight-Based Dosing of Unfractionated Heparin:A Retrospective Cohort Study Seth R. Bauer, PharmD; Narith N. Ou, PharmD; Benjamin J. Dreesman, PharmD; Jeffrey J. Armon, PharmD; Jan A. Anderson, PharmD; Stephen S. Cha, MS; and Lance J. Oyen, PharmD OBJECTIVE: To assess bleeding and activated partial thromboplastin time (APTT) in relation to body mass index (BMI) in patients prescribed weight-based dosing of intravenous unfractionated heparin (UFH) for cardiac indications without a maximum (dosecapped) initial bolus or capped initial infusion rate. PATIENTS AND METHODS:Consecutive patients admitted to an academic medical center from February 1, 2002, through November 31, 2003, who were treated with a UFH nomogram consisting of a 60-U/kg intravenous bolus plus an initial continuous intravenous infusion of 12 U/kg hourly and titrated to a goal APTT range corresponding to thromboplastin-adjusted target heparin levels of 0.3 to 0.7 U/mL by anti-Xa assay were evaluated for this retrospective cohort study. Patients were excluded if they concomitantly received a fibrinolytic, glycoprotein IIb/IIIa inhibitor, or any other antithrombotic agent (except warfarin). Study patients were divided into quartiles by BMI. RESULTS:Of the 1054 patients included in the study, 807 (76.6%) had an initial bolus dose higher than 4000 U, and 477 (45.3%) had an initial infusion rate higher than 1000 U/h. Despite a significant difference among BMI quartiles in proportion of supratherapeutic first APTT values (P<.001), no statistically significant difference was found in bleeding frequency (P=.26) or frequency of first APTT within the goal range (P=.27). Logistic regression analyses revealed that BMI was not a significant predictor of bleeding or first APTT within the goal range. CONCLUSION:We did not find any difference in the proportion of first APTT values in the goal range or an increased risk of bleeding in obese patients treated with UFH without a capped initial dose. Our data demonstrate the safe use of weight-based UFH without a capped initial bolus dose or capped initial infusion rate in patients with medical cardiac conditions. Proc. 2009;84(12):1073-1078 APTT = activated partial thromboplastin time; BMI = body mass index; CI = confidence interva...

To overcome errors in prescribing, calculating doses, and monitoring intravenous heparin, a computerized heparin nomogram system (HepCare) was developed to improve heparin safety using interactive cues between the prescriber, nurse, pharmacist, and the laboratory. The frequency of deviations decreased from 0.5 per patient before HepCare with the protocol to 0.006 per patient with HepCare and the protocol. The goal activated partial thromboplastin time results of the HepCare system (group I) were compared with patients who were not treated using the HepCare system (group II). There was a higher mean percentage of activated partial thromboplastin times within goal range in group I vs. II-44% vs. 27% (p<0.01). There were reminders of a drop in platelet count in 6% of patients, hemoglobin drop in 0.7%, and validation activated partial thromboplastin time values in 7% of patients by HepCare. HepCare-guided intravenous heparin resulted in significant improvements in safety, quality assurance, and targeted activated partial thromboplastin time values.

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