Average-Weight Methodology in Weight-Based Unfractionated Heparin Therapy in the Presence of Obesity

Safani, Michael; Tobias, Serge; Robinson, Michelle; Hwang, J. Y.; Thomas, Gregory S.

doi:10.1016/j.chest.2016.12.016

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…14 The dosing of which is discussed in detail elsewhere. 15 Despite limitations, aPTT remains the most convenient and frequently used method for monitoring in vivo heparin response. It should be measured minutes after initial medication bolus to confirm therapeutic effect and continuously monitored to gauge needed changes to the continuous rate.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Perioperative Outcomes are Adversely Affected by Poor Pretransfer Adherence to Acute Limb Ischemia Practice Guidelines

Wang

Murphy

Gutwein

et al. 2018

Annals of Vascular Surgery

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Section: Accepted Manuscriptmentioning

confidence: 99%

Perioperative Outcomes are Adversely Affected by Poor Pretransfer Adherence to Acute Limb Ischemia Practice Guidelines

Wang

Murphy

Gutwein

et al. 2018

Annals of Vascular Surgery

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“…We previously validated successful use of the weight-adjusted, weight-based approach to UFH dosing in the presence of obesity in a small number of patients and employed the same approach in the current UFH protocol. 22,23 In this communication, we describe the first comprehensive, weight-adjusted, weight-based UFH protocol in conjunction with various DOACs and report on the efficacy and safety outcomes in patients with a wide spectrum of BMI. The systematic steps in this UFH protocol are guided by incremental ACT measurements and executed by skilled nursing staff, allowing the electrophysiologist to devote his/her attention solely to the performance of the procedure.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comprehensive Intraprocedural Unfractionated Heparin Protocol During Catheter Ablation of Atrial Fibrillation in the Presence of Direct Oral Anticoagulants and Wide Spectrum of Body Mass Index

Safani

Tobias

Shandling

et al. 2021

J Cardiovasc Pharmacol Ther

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Introduction: Data on optimal dosing of unfractionated heparin (UFH) in the presence of a direct oral anticoagulant (DOAC) to achieve and maintain an activated clotting time (ACT) of ≥300 seconds during catheter ablation of atrial fibrillation (CA-AF) are limited and prevalence of obesity adds to the unpredictable response to UFH. Methods and Results: One hundred seventeen consecutive patients undergoing CA-AF were prospectively administered weight-adjusted, weight-based UFH using a pre-specified detailed protocol and retrospectively analyzed. Due to lack of distribution of UFH into muscle or adipose tissue and lower degree of vascularity in the latter compartment, each patient’s ideal and actual weights were used to determine the adjusted-weight for use in all UFH doses. A UFH bolus of 200 units/kg was administered intravenously followed by an infusion of 35 units/kg/hour. The mean age was 65 years, and 85 patients (72.6%) were male. The average body mass index (BMI) was 30 (range 18-50) kg/m2. After the initial UFH bolus dose, 99 patients (84.6%) achieved ACT ≥300 sec with a mean (± SD) of 380 ± 79 sec. The mean time to reach an ACT ≥300 in all patients was 14.6 ± 12.4 minutes. Among all measured ACT values, 423 (90.8%) were ≥300 seconds. These results were consistent within all BMI categories. There were no intraprocedural thrombotic or hemorrhagic complications. Two patients (1.7%) sustained groin vascular access site hematoma without subsequent intervention and 7 patients (6%) experienced minor oozing post-procedurally. Conclusions: Our comprehensive weight-adjusted, weight-based UFH protocol, during CA-AF in presence of a DOAC, rapidly achieved and maintained an effective ACT irrespective of BMI.

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“…[1][2][3] Even though several case reports and studies have been published exploring outcomes with weight-based dosing of UFH in obese and morbidly obese patients, the methodologies, indications for use, and results are highly mixed, making consensus difficult. [4][5][6][7][8][9][10][11][12][13][14][15][16] The largest study to date, which consisted of 1054 patients who received UFH dosed using ABW without a dose cap, demonstrated no differences in Unfractionated heparin infusion for treatment of venous thromboembolism based on actual body weight without dose capping percent of initial aPTTs within goal range. Because this study was conducted in patients with non-VTE indications, such as acute coronary syndrome and atrial fibrillation, where a lower UFH bolus, rate, and aPTT were utilized, applicability to patients with VTE is unclear.…”

Section: Introductionmentioning

confidence: 99%

Unfractionated heparin infusion for treatment of venous thromboembolism based on actual body weight without dose capping

et al. 2019

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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/m2), obese (30–39.9 kg/m2), and morbidly obese (⩾ 40 kg/m2). 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.

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Average-Weight Methodology in Weight-Based Unfractionated Heparin Therapy in the Presence of Obesity

Cited by 3 publications

References 12 publications

Perioperative Outcomes are Adversely Affected by Poor Pretransfer Adherence to Acute Limb Ischemia Practice Guidelines

Perioperative Outcomes are Adversely Affected by Poor Pretransfer Adherence to Acute Limb Ischemia Practice Guidelines

Comprehensive Intraprocedural Unfractionated Heparin Protocol During Catheter Ablation of Atrial Fibrillation in the Presence of Direct Oral Anticoagulants and Wide Spectrum of Body Mass Index

Unfractionated heparin infusion for treatment of venous thromboembolism based on actual body weight without dose capping

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