The Impact of Obesity on the Effect of Intravenous Heparin Using a Standardized Dosing Nomogram.

Barletta, Jeffrey F.; DeYoung, Jaculin L.; McAllen, Karen; Baker, Ryan; Pendleton, Kevin

doi:10.1097/00003246-200612002-00520

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“…Several small, retrospective chart reviews 11–13 and a case report 14 have examined the issue of UFH dosing in obesity, noting the lack of standardized obesity definitions that warrant an adjustment in UFH dosing. Overanticoagulation was often observed in these patients, even with the use of various UFH dosage adjustments to account for obesity.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of a High-Intensity, Weight-Based, Intravenous Heparin Protocol Revision in Patients who are Obese

Dee

Thomas

2008

Hosp Pharm

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Purpose Data collected previously within this institution concluded that the initial heparin infusion rate in the high-intensity, weight-based, intravenous (IV) heparin protocol should be adjusted from 18 to 15 units/kg/h (based on actual body weight) in patients who are more than 50% above ideal body weight (IBW). The purpose of this study was evaluation of the safety and efficacy of the revised protocol. Methods A retrospective chart review was conducted from the initiation of the revised protocol on October 28, 2006, through March 15, 2007. All patients receiving high-intensity, weight-based heparin dosing were eligible for inclusion. Outcome measures included percentage of patients achieving therapeutic activated partial thromboplastin time (aPTT), time to first therapeutic aPTT, follow-up aPTT levels, adverse event occurrence, venous thromboembolism recurrence, and influence of concomitant disease states. Results A total of 55 regimens met inclusion criteria. There were no statistically significant differences between patients who were obese (greater than 50% above IBW) and those who were not obese (less than 50% above IBW) with respect to percentage achieving a therapeutic aPTT, time to therapeutic aPTT, or follow-up aPTT values. Patients who were more than 50% above IBW had improved therapeutic anticoagulation parameters postrevision, whereas patients who were 30% to 50% above IBW had worsened therapeutic anticoagulation parameters postrevision. Although the 30% to 50% IBW class had the highest incidence of end-stage renal disease, it appears that the group of patients in this class was overanticoagulated as a whole. Conclusion The institution's revised, high-intensity, weight-based, IV heparin protocol was found safe and effective, validating a potential heparin dosing adjustment for patients who are obese.

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