Unfractionated heparin anticoagulation using estimated blood volume based dosing versus weight-based dosing in a Veteran population

Gillette, Michael A.; Franck, Andrew J.; Reeder, Don N.; Knott, Amanda; Frohnapple, David J.

doi:10.2146/sp150027

Cited by 4 publications

(3 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clinical utility has been suggested with this strategy in a previous study assessing therapeutic anticoagulation with UFH. 2 We sought to describe the relationship between EBV, daily UFH dose, and the incidence of VTE and bleeding in underweight (≤50 kg or BMI ≤18.5 kg/m 2 ), critically ill patients.…”

mentioning

confidence: 99%

Exploration of an Association Between UFH Dosing Based on Estimated Blood Volume and Venous Thromboembolism and Bleeding in the Underweight and Critically Ill

Carter¹,

Betthauser²,

Peppard³

2020

Ann Pharmacother

View full text Add to dashboard Cite

We undertook a post hoc analysis of study data published in the journal to further investigate the association between bleeding risk and the use of venous thromboembolism (VTE) prophylaxis in underweight, critically ill patients and to optimize its dosing. 1 Given the low volume of distribution and 1-compartment model of unfractionated heparin (UFH), dosing based on estimated blood volume (EBV) could be used to improve safety and efficacy. Clinical utility has been suggested with this strategy in a previous study assessing therapeutic anticoagulation with UFH. 2 We sought to describe the relationship between EBV, daily UFH dose, and the incidence of VTE and bleeding in underweight (≤50 kg or BMI ≤18.5 kg/m 2), critically ill patients. We performed a post hoc analysis of a retrospective cohort study that included adult intensive care unit patients who received standard-or reduced-dose VTE prophylaxis at a large academic medical center from September 2009 to March 2014. EBV was calculated using Nadler's formula. 3 Patients were stratified into lowdose UFH (<3.5 U/mL/d) and high-dose UFH (≥3.5 U/ mL/d) groups. This cutoff was derived from mean population kinetic data suggesting that a typical patient (EBV of 4.3 L) who receives UFH 5000 units subcutaneously every 8 hours would be exposed to ~3.5 U/mL/d. 4 The primary end point assessed was the prevalence of clinically relevant bleeding and VTE in each group. A total of 255 patients were included in the analysis; 84 patients were included in the low-dose group, and 171

show abstract

mentioning

confidence: 99%

Exploration of an Association Between UFH Dosing Based on Estimated Blood Volume and Venous Thromboembolism and Bleeding in the Underweight and Critically Ill

Carter¹,

Betthauser²,

Peppard³

2020

Ann Pharmacother

View full text Add to dashboard Cite

show abstract

“…36 A small study of 32 patients who received unfractionated heparin infusions showed that EBV-based dosing was associated with a nonsignificant decrease in time to therapeutic range as well as an increase in the percentage of patients with first anti-Xa level within therapeutic range compared to weight-based dosing. 37 In a recent study in trauma patients, EBV (rho = 0.57) had a higher correlation with anti-Xa levels compared to BMI (rho = 0.20) and TBW (rho = 0.46). 23 Dose-per-unit EBV (aOR 2.54) and dose-per-unit TBW (aOR 1.89)…”

Section: Discussionmentioning

confidence: 89%

“…Since all heparins remain primarily in the intravascular space after intravenous administration or subcutaneous absorption, it is logical that EBV may be the best predictor of dose needed 36 . A small study of 32 patients who received unfractionated heparin infusions showed that EBV‐based dosing was associated with a nonsignificant decrease in time to therapeutic range as well as an increase in the percentage of patients with first anti‐Xa level within therapeutic range compared to weight‐based dosing 37 . In a recent study in trauma patients, EBV (rho = 0.57) had a higher correlation with anti‐Xa levels compared to BMI (rho = 0.20) and TBW (rho = 0.46) 23 .…”

Section: Discussionmentioning

confidence: 99%

Multicenter study evaluating target attainment of anti‐Factor Xa levels using various enoxaparin prophylactic dosing practices in adult trauma patients

Chanas,

Gibson,

Langenstroer

et al. 2024

Pharmacotherapy

View full text Add to dashboard Cite

Enoxaparin is standard of care for venous thromboembolism (VTE) prophylaxis in adult trauma patients, but fixed‐dose protocols are suboptimal. Dosing based on body mass index (BMI) or total body weight (TBW) improves target prophylactic anti‐Xa level attainment and reduces VTE rates. A novel strategy using estimated blood volume (EBV) may be more effective based on results of a single‐center study. This study compared BMI‐, TBW‐, EBV‐based, and hybrid enoxaparin dosing strategies at achieving target prophylactic anti‐Factor Xa (anti‐Xa) levels in trauma patients.This was a multicenter, retrospective review of adult trauma patients who received enoxaparin twice daily for VTE prophylaxis and had at least one appropriately timed anti‐Xa level (collected 3 to 6 hours after the previous dose after three consecutive doses) from January 2017 through December 2020. Patients were excluded if the hospital‐specific dosing protocol was not followed or if they had thermal burns with > 20% body surface area involvement. The primary outcome was percentage of patients with peak anti‐Xa levels within the target prophylactic range (0.2‐0.4 units/mL).Nine hospitals enrolled 742 unique patients. The most common dosing strategy was based on BMI (43.0%), followed by EBV (29.0%). Patients dosed using EBV had the highest percentage of target anti‐Xa levels (72.1%). Multiple logistic regression demonstrated EBV‐based dosing was significantly more likely to yield anti‐Xa levels at or above target compared to BMI‐based dosing (adjusted odds ratio (aOR) 3.59, 95% confidence interval (CI) 2.29‐5.62, p < 0.001). EBV‐based dosing was also more likely than hybrid dosing to yield an anti‐Xa level at or above target (aOR 2.30, 95% CI 1.33‐3.98, p = 0.003). Other pairwise comparisons between dosing strategy groups were nonsignificant.An EBV‐based dosing strategy was associated with higher odds of achieving anti‐Xa level within target range for enoxaparin VTE prophylaxis compared to BMI‐based dosing and may be a preferred method for VTE prophylaxis in adult trauma patients.

show abstract

Heparin

2016

Reactions Weekly

View full text Add to dashboard Cite

S HeparinBright red blood per rectum: case report In a retrospective study, a male patient [exact age at reaction onset not stated] experienced bright red blood per rectum during treatment with heparin [indication, dosage, route, duration of treatment to reaction onset and outcome not stated].Author comment: "There was one minor bleed in the [estimated blood volume] dosing group compared to 3 minor bleeds in the [weight-based] dosing group (p = 0.323), which included one case of bright red blood per rectum."Gillette MA, et al. Unfractionated heparin anticoagulation using estimated blood volume based dosing versus weight-based dosing in a Veteran population.

show abstract

Unfractionated heparin anticoagulation using estimated blood volume based dosing versus weight-based dosing in a Veteran population

Abstract: EBV dosing achieved quick therapeutic anticoagulation with less bleeding compared to WB dosing in a veteran population. Due to the study's limitations, larger, randomized, comparative trials are needed to confirm our findings.

Cited by 4 publications

References 17 publications

Exploration of an Association Between UFH Dosing Based on Estimated Blood Volume and Venous Thromboembolism and Bleeding in the Underweight and Critically Ill

Exploration of an Association Between UFH Dosing Based on Estimated Blood Volume and Venous Thromboembolism and Bleeding in the Underweight and Critically Ill

Multicenter study evaluating target attainment of anti‐Factor Xa levels using various enoxaparin prophylactic dosing practices in adult trauma patients

Heparin

Contact Info

Product

Resources

About