Evaluation of Weight-Based Dosing of Unfractionated Heparin in Obese Children

Modeling of Body Weight Metrics for Effective and Cost-Efficient Conventional Factor VIII Dosing in Hemophilia A Prophylaxis

“…As a result, overweight and obese patients are likely overdosed when dose is calculated using total body weight [ 23 ]. A similar issue has been noted for dosing of unfractionated heparin, another compound whose volume of distribution is approximately equal to the plasma volume; obese children achieved comparable anticoagulation at a lower weight-based dose [ 24 ]. Hemophilia treatment is expensive, with annual costs in the hundreds of thousands for those on prophylaxis [ 2 ], and while prophylaxis does achieve better health outcomes, these come at a significant cost that is not automatically offset by prevention of other expenses [ 25 ].…”

Influence of Body Mass Index on the Activated Clotting Time Under Weight‐Based Heparin Dose

“…Therefore, the activated clotting time (ACT) has been successfully applied during PCI to monitor the extent of thrombin inhibition and anticoagulation from UFH, aiming to reduce the incidence of thrombotic adverse events and hemorrhagic complications . In addition, previous studies have revealed that a weight‐based dosing regimen have been widely implemented in hospitals and have become the standard administration technique for UFH ; while the weight‐based loading dose of UFH was increasingly challenged, especially for the overweight patients displaying the limitations of a standardized weight‐based nomogram for UFH dosing . Specifically, the volume of distribution of UFH acoincides with blood volume, adipose tissue has a smaller blood volume than lean tissue, and dosing based on actual body weight may result in excessive UFH administration in obesity patients and, consequently, increased risk of adverse events .…”

Unfractionated heparin using actual body weight without dose capping in obese pediatric patients—Subgroup analysis from an observational cohort study

“…Taylor and colleagues subsequently reported a retrospective case‐matched study of 50 children (25 obese) who received weight‐based UFH infusion. They noted that obese children required lower doses of UFH than nonobese children to maintain comparable anticoagulation 5 …”

“…Obesity is an increasingly common occurrence in pediatric medicine, with an estimated 17% of children/adolescents in the United States being classified as obese 1 . Though adult data suggest that dosing unfractionated heparin (UFH) based on actual body weight without a dose cap in obese patients may be safe, pediatric data regarding this practice are scarce 2–5 . We have previously reported results of an observational cohort study conducted over 20 months, establishing the use of an anti‐factor Xa (anti‐FXa)‐based nomogram to monitor UFH use in children 3 .…”