Obesity

Heparin dvt prophylaxis dose obesity – High-Dose Unfractionated Heparin in Overweight and Obese Patients

Media Center ACC. Want to use this article elsewhere?

The purpose of this paper is to assist clinicians with dosing regimens for medications commonly used as part of the supportive care and prophylaxis in critically ill obese patients. There is wide disparity in the doses of low molecular weight heparin utilized, the patient populations studied and the degree of obesity present among the patients. PubMed Article Google Scholar Prophylaxis in the ICU is typically provided with low molecular weight heparin or unfractionated heparin using a fixed dosing strategy as recommended by the package insert. References 1. Obesity is a well-known risk factor for venous thromboembolism VTE in both critically ill and non-critically ill patients.

  • Study Questions: Does high-dose unfractionated heparin safely and effectively prevent venous thromboembolism VTE in overweight and obese patients? Surg Endosc.

  • Email Alerts Don't miss a single issue. Although the sample size obtained was short of the initial goal, the overall incidence of VTE was similar between the high-dose and low-dose groups 3 vs.

  • To see the full article, log in or purchase access.

  • Pharmacologic prophylaxis of deep vein thrombosis and venous thromboembolism VTE is an important aspect of medical care, particularly in the inpatient setting.

  • Devine BJ. If a weight-based method is chosen, seek consistency between using ideal or adjusted body weight across different vasopressor agents e.

Letters to the Editor

References show all references 1. Delzell Jr. J Thromb Thrombolysis. Conclusions: High-dose unfractionated heparin did not reduce the incidence of VTE in a cohort of hospitalized overweight and obese patients.

Availability of data and materials Not applicable. Download PDF. In-hospital VTE rates did not differ significantly between the high-dose and standard-dose groups 3. Overall, there was no difference in the risk of in-hospital VTE in the high-dose arm vs. Finally, one prospective trial evaluated a BMI-stratified dosing approach in a cohort of bariatric surgery patients [ 60 ].

  • Jun 1, Issue. Giapreza angiotensin II [package insert].

  • J Thromb Thrombolysis. Log in Best Value!

  • This was a single-center retrospective observational cohort study at a large academic medical center. Summary: Critically ill obese patients who receive low molecular weight heparin require a higher dosage for VTE prophylaxis than patients who are not obese.

  • Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review.

  • Download citation. The findings from this study are inconsistent with those observed in the bariatric population, where high-dose unfractionated heparin has been shown to reduce the incidence of VTE without a major increase in bleeding.

E-mail: lawrencegibbs mhd. Safety obeskty efficacy of high-dose unfractionated heparin for prevention of venous thromboembolism in overweight and obese patients. Standard weight-based heparin dosing protocols that specify maximum doses for initial bolus and infusion rates can result in significant delays in time to achieve therapeutic anticoagulation in the obese and morbidly obese patient. The patient developed bloody pulmonary secretions with a therapeutic aPTTnecessitating the discontinuation of the heparin infusion.

Patients were excluded if they were receiving enoxaparin or therapeutic anticoagulation; if they were admitted with VTE or bleeding; if they were pregnant, peripartum, imprisoned, or paraplegic; if they had a history of heparin-induced thrombocytopenia; or if they underwent surgery. Am J Crit Care. The case for rabeprazole. Heparin dosing for venous thromboembolism prophylaxis in obese hospitalized patients: an observational study.

Introduction

Best Value! Apr 15, Issue. Choose a single article, issue, or full-access subscription. Efficacy and safety of high-dose thromboprophylaxis in morbidly obese inpatients. Trends in obesity among adults in the United States, to

We agree that direct oral anticoagulant use in patients with a Svt greater than 40 kg per m 2 has not been adequately studied and should be avoided. Get immediate access, anytime, anywhere. Pharmacologic prophylaxis of deep vein thrombosis and venous thromboembolism VTE is an important aspect of medical care, particularly in the inpatient setting. In the last several decades, the prevalence of obesity in the United States has increased significantly. Log in.

In-hospital VTE rates did not differ significantly between the high-dose and standard-dose groups 3. Efficacy and safety of high-dose subcutaneous unfractionated heparin prophylaxis for the prevention of venous thromboembolism in obese hospitalized patients. Patients were excluded if they were receiving enoxaparin or therapeutic anticoagulation; if they were admitted with VTE or bleeding; if they were pregnant, peripartum, imprisoned, or paraplegic; if they had a history of heparin-induced thrombocytopenia; or if they underwent surgery. Does high-dose unfractionated heparin safely and effectively prevent venous thromboembolism VTE in overweight and obese patients? We describe a kg man who was started on an intravenous infusion of heparin according to hospital protocol for suspected pulmonary embolism. Study Questions: Does high-dose unfractionated heparin safely and effectively prevent venous thromboembolism VTE in overweight and obese patients? Gibbs and Sheley for raising an important issue regarding our article.

Sign up for the free AFP email table of contents. Sign up for the free AFP email table of contents. Get Permissions. The editors may edit letters to meet style and space requirements.

Study Questions:

Heart failure was more common in the high-dose obese class III group. Possible conflicts of interest must be disclosed at time of submission. Jared P. The editors may edit letters to meet style and space requirements. Rates of VTE within 30 days of hospitalization did not differ significantly between the high-dose and standard-dose groups 1.

In our experience, treatment of acute VTE in patients who are morbidly obese is most safely achieved by using intravenous unfractionated heparin and concomitant warfarin. Log in. Clinical Question Is high-dose heparin better than standard-dose heparin in reducing the incidence of venous thromboembolism VTE in obese inpatients? Despite limited data on heparin dosing in obesity, we recommend the use of a dosing weight to determine initial heparin dosing when treating venous thromboembolism in morbidly obese patients. We agree that direct oral anticoagulant use in patients with a BMI greater than 40 kg per m 2 has not been adequately studied and should be avoided. It should be noted that all data regarding anti— factor Xa levels used tests specifically calibrated for the drug being tested or mass spectrometry drug levels. Choose a single article, issue, or full-access subscription.

Drug dosing in the critically ill obese patient: a focus on medications for hemodynamic support and prophylaxis. Sign Up Now. The drug doses that are included, however, are often formulated for patients with normal body habitus and do not account for the pharmacokinetic variability encountered with obesity. Google Scholar 2.

Clinical Question

Media Center ACC. References 1. Additionally, no significant difference was found after adjusting for BMI. Hosp Pharm.

Best Value! Safety and efficacy of high-dose dose obesity heparin for prevention of venous thromboembolism in overweight and obese patients. We describe a kg man who was started on an intravenous infusion of heparin according to hospital protocol for suspected pulmonary embolism. High-dose unfractionated heparin did not reduce the incidence of VTE in a cohort of hospitalized overweight and obese patients. Additionally, no significant difference was found after adjusting for BMI. Monitoring enoxaparin with antifactor xa levels in obese patients. Log in.

Already a member or subscriber? Implementation of an enoxaparin protocol for venous thromboembolism prophylaxis in obese surgical intensive care unit patients. Impact of body mass index formula with example what is segmentation guideline for weight-based antimicrobial dosing in morbidly obese adults and comprehensive literature review. Quantification of lean bodyweight. The primary outcome was achievement of target anti-Xa level 0. Withholding pantoprazole for stress ulcer prophylaxis in critically ill patients: a pilot randomized clinical trial and meta-analysis. Delzell Jr.

Study Questions:

Jun 1, Issue. The focus will be on adult patients with more severe forms of obesity i. There are limited studies evaluating the pharmacokinetics of acid suppressive medications in obesity and none are specific to ICU patients for the provision of SUP.

Arch Intern Med. Withholding pantoprazole for stress doxe prophylaxis in critically ill patients: a pilot randomized clinical trial and meta-analysis. J Crit Care. The focus will be on adult patients with more severe forms of obesity i. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

In most patients heparin dvt prophylaxis dose obesity more than lb kghigh-dose heparin prophylaxis 7, units subcutaneously three times per day does not further reduce the risk of VTE compared with standard-dose heparin 5, units subcutaneously two dode three times per day. More in Pubmed Citation Related Articles. Read the Issue. There was no difference between groups in rates of bleeding. Lovenox enoxaparin [prescribing information]. Letters submitted for publication in AFP must not be submitted to any other publication. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

Publication types

Heparin dvt prophylaxis dose obesity series is coordinated by John E. The LMWH agent enoxaparin Lovenox has no official dosing recommendations for these patients, 3 but data in this population suggest that a reduced weight-based dose less than 1 mg per kg is warranted. The patient later died after developing pulseless electrical activity. The most validated parenteral agent to prevent VTE in morbidly obese hospitalized patients is enoxaparin, dosed at 40 mg subcutaneously SC twice daily.

Dosing of neuromuscular blocking agents in obesiyt with obesity: a narrative review. More in Pubmed Citation Related Articles. Variability in dobutamine pharmacokinetics in unstable critically ill surgical patients. Download references. Unfractionated heparin dosing has also been evaluated in obese hospitalized patients Additional file 1 [ 707172 ]. Br J Anaesth. Major bleeding was defined as a hemoglobin decrease of at least 2 g per dL 20 g per L in 24 hours, transfusion of at least two units of blood products, or critical bleeding e.

READ TOO: Different Types Of Treatment For Obesity

Heart failure was more common in the high-dose obese class III group. Most data in this area are from studies that utilize pharmacokinetic variables, surrogate markers for efficacy or physicochemical characteristics. Ideal body weight characterizes weight based on height and gender. The weight metrics most commonly referenced when dosing medications in the ICU are total body weight or some alternative, such as ideal body weight IBWlean body weight LBW or adjusted body weight Table 1. The results from the primary literature search were reviewed and pertinent articles were retained.

Br J Surg. Prevalence of obesity and severe obesity among adults: United States, — Anaesth Intensive Care in press. Patients were excluded if they were receiving enoxaparin or therapeutic anticoagulation; if they were vdt with VTE or bleeding; if they were pregnant, peripartum, imprisoned, or paraplegic; if they had a history of heparin-induced thrombocytopenia; or if they underwent surgery. The medications reviewed for evaluation consisted of those used for supportive care or prophylaxis mentioned in evidence-based guidelines. The weight metrics most commonly referenced when dosing medications in the ICU are total body weight or some alternative, such as ideal body weight IBWlean body weight LBW or adjusted body weight Table 1.

  • Pharmacokinetic and clinical trials involving low molecular weight heparin and unfractionated heparin. Introduction Medications for supportive care and prophylaxis constitute a large proportion of drug use in the intensive care unit ICU.

  • Read the full article.

  • Failure to account for the pharmacokinetic changes that occur with obesity can lead to an incorrect dose and treatment failure or toxicity.

  • Brian L.

  • Consequences of using an incorrect weight metric when dosing weight-based medications in obese patients. Rabeprazole is metabolized by a non-enzymatic process.

Most data in this area are from studies that utilize pharmacokinetic variables, surrogate markers for efficacy or physicochemical characteristics. Already a member or subscriber? Received : 17 November Relevant manuscripts were reviewed and strategies for dosing are provided.

Hypothalamic-pituitary-adrenal axis dose obesity and cortisol activity in obesity: a systematic review. Furthermore, there are few studies focused on clinical outcomes such as VTE incidence; instead, most endpoints were directed toward surrogate markers e. Patients were subdivided into 4 groups based on their body mass index BMI : Overweight Evaluating the impact of obesity on safety and efficacy of weight-based norepinephrine dosing in septic shock: a single-center, retrospective study. Unfortunately, clinical trials comparing effectiveness in obese patients are lacking.

FPIN's Help Desk Answers

Major bleeding was defined as a hemoglobin decrease of at least 2 g per dL 20 g per L in 24 hours, transfusion of at least two units of blood products, or critical bleeding e. Norepinephrine kinetics and dynamics in septic shock and trauma patients. Body mass index and risk of nonalcoholic fatty liver disease: two electronic health record prospective studies.

Best Value! To the Editor: We read the article on venous thromboembolism VTE with interest and appreciate that the authors highlight the different heparin dvt prophylaxis dose obesity options for this disease state. Trends in obesity among adults in the United States, to Media Center ACC. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Patients were subdivided into 4 groups based on their body mass index BMI : Overweight Already a member or subscriber?

Obesity is wide heparun in the doses of low molecular weight heparin utilized, the patient populations studied and the degree of obesity present among the patients. A retrospective cohort study included 2, obese adult inpatients receiving subcutaneous heparin for VTE prophylaxis. Adjusted body weight using a correction factor i. Best Value! Efficacy and safety of high-dose subcutaneous unfractionated heparin prophylaxis for the prevention of venous thromboembolism in obese hospitalized patients.

FPIN's Help Desk Answers

Drug dosing in the critically ill obese patient-a focus on sedation, analgesia, and delirium. Hosp Pharm. Thromb Haemost.

Purchase Access: See My Options close. Weight-based enoxaparin dosing for venous thromboembolism prophylaxis in the obese trauma patient. Adjusted body heoarin is roughly equivalent to LBW and for the purposes of this paper will be considered a surrogate for LBW because of familiarity and ease of calculation. Similarly, medications for stress ulcer prophylaxis do not need to be adjusted. The authors concluded doses based on IBW and not total body weight were recommended.

Get Permissions. Major bleeding was defined as a hemoglobin decrease of at least 2 g per dL 20 g per L in 24 hours, transfusion of at least two units of blood products, or critical bleeding e. Suggestions were then formed using the available data based on the following prioritization strategy: studies evaluating clinical outcomes, pharmacokinetics, adverse effect profiles and physicochemical properties. Medications for supportive care and prophylaxis constitute a large proportion of drug use in the intensive care unit ICU. Adjusted body weight is roughly equivalent to LBW and for the purposes of this paper will be considered a surrogate for LBW because of familiarity and ease of calculation. Thromb Res. Brian L.

The International Society on Thrombosis and Haemostasis offers some guidance. Sign Up Now. E-mail: lawrencegibbs mhd.

  • All of these issues complicate the choice of an appropriate size descriptor when considering weight-based dosing regimens.

  • Any documented bleeding that did not meet the criteria for major bleeding was considered minor bleeding.

  • Am J Gastroenterol. J Thromb Thrombolysis.

Barletta Authors Brian L. Author disclosure: No relevant financial affiliations. Am J Gastroenterol. The incidence of VTE was 9. Stress ulcer prophylaxis Acid suppressive therapy is routinely administered to critically ill patients for the prevention of clinically important gastrointestinal bleeding CIB due to stress ulcers.

If a vitamin K antagonist and bridging with LMWH is used, it is also important to note the limited data and different pharmacokinetic and heparin dvt prophylaxis dose obesity properties in patients who are morbidly obese. Patients were excluded if they were receiving enoxaparin or therapeutic anticoagulation; if they were admitted with VTE or bleeding; if they were pregnant, peripartum, imprisoned, or paraplegic; if they had a history of heparin-induced thrombocytopenia; or if they underwent surgery. More in Pubmed Citation Related Articles. Contact afpserv aafp. Heart failure was more common in the high-dose obese class III group. To see the full article, log in or purchase access.

To see the full article, log in or purchase access. Pharmacologic prophylaxis of deep vein thrombosis and venous thromboembolism VTE is an important aspect of medical care, particularly in the inpatient setting. Read the Issue. High-dose unfractionated heparin was associated with a longer length of stay across all BMI groups, but no difference in mortality was observed.

Hosp Pharm. Major bleeding was defined as a hemoglobin decrease of at least 2 g per dL 20 g per L in 24 heparin dvt prophylaxis dose obesity, transfusion of at least two units of blood products, or critical bleeding e. In Reply: We thank Drs. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

  • Most data in this area are from studies that utilize pharmacokinetic variables, surrogate markers for efficacy or physicochemical characteristics. Does body weight impact the efficacy of vasopressin therapy in the management of septic shock?

  • Want to use this article elsewhere? This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

  • Overall, these studies have demonstrated no differences based on BMI. One size does not fit all in severe infection: obesity alters outcome, susceptibility, treatment, and inflammatory response.

Major bleeding was defined as a hemoglobin decrease prophulaxis at least 2 g per dL 20 g per L in 24 hours, transfusion of at least two units of blood products, or critical bleeding e. Am Fam Physician. To see the full article, log in or purchase access. More in Pubmed Citation Related Articles. Delzell Jr. There was no difference between groups in rates of bleeding.

The incidence of VTE was 9. Am J Gastroenterol. High-dose unfractionated heparin did not reduce the incidence of VTE in a cohort of hospitalized overweight and obese patients. Variability in dobutamine pharmacokinetics in unstable critically ill surgical patients. Surg Obes Relat Dis.

Clinical Question

References 1. Obese children require lower doses of pantoprazole than nonobese peers to achieve equal systemic drug exposures. Methodology The medications reviewed for evaluation consisted of those used for supportive care or prophylaxis mentioned in evidence-based guidelines.

Consent for publication Not applicable. These studies have revealed PPI exposure correlates best with lean body weight dosing as opposed to actual body weight [ 4849 ]. Surg Obes Relat Dis. Erstad declares that the he has no competing interests. Want to use this article elsewhere? Email Alerts Don't miss a single issue.

  • These studies have revealed PPI exposure correlates best with lean body weight dosing as opposed to actual body weight [ 4849 ].

  • Monitoring of anti-factor Xa levels to guide prophylactic dosing is an option, although the utility of this lab test is limited, as target anti-Xa ranges for VTE prophylaxis have not been universally defined and trials have not shown a clear link between anti-factor Xa levels and bleeding or thrombotic events.

  • Venous thromboembolism prophylaxis Obesity is a well-known risk factor for venous thromboembolism VTE in both critically ill and non-critically ill patients. Most data originate from pharmacokinetic studies conducted in healthy volunteers or symptom-related outcomes in patients with gastroesophageal reflux disease GERD.

  • Major bleeding was defined as a hemoglobin decrease of at least 2 g per dL 20 g per L in 24 hours, transfusion of at least two units of blood products, or critical bleeding e.

Best Prophylaxis dose It should be noted that all data regarding anti— factor Xa levels used tests specifically calibrated for the drug being tested or mass spectrometry drug levels. Answers are drawn from an approved set of evidence-based resources and undergo peer review. Does high-dose unfractionated heparin safely and effectively prevent venous thromboembolism VTE in overweight and obese patients? The complete database of evidence-based questions and answers is copyrighted by FPIN.

Navigate this Article. Sign Up Now. Lovenox enoxaparin [prescribing information]. Get immediate access, anytime, anywhere.

A person viewing it online may make one printout of the material and may use that printout only for his or prophylaxis dose obesity personal, non-commercial reference. Bridgewater, N. Efficacy and safety of high-dose subcutaneous unfractionated heparin prophylaxis for the prevention of venous thromboembolism in obese hospitalized patients. In the last several decades, the prevalence of obesity in the United States has increased significantly. Contact afpserv aafp.

Adjusted body weight using a correction factor i. Sign Up Now. Availability of information for dosing injectable medications in underweight or obese patients. Quantification of lean bodyweight.

Next, obfsity heparin dosing was evaluated in a heparin dvt prophylaxis dose obesity study of neurocritical care patients [ 72 ]. This was a single-center retrospective observational cohort study at a large academic medical center. Strength of Recommendation: B, based on retrospective cohort studies. PubMed Article Google Scholar Study Questions: Does high-dose unfractionated heparin safely and effectively prevent venous thromboembolism VTE in overweight and obese patients?

Unfractionated heparin dosing has also been evaluated in obese hospitalized patients Additional file 1 [ 707172 ]. Bibliographies were reviewed for any articles that may have been missed by the primary literature search. Author disclosure: No relevant financial affiliations. Am J Health Syst Pharm.

Obeeity were not included given the overarching theme of this manuscript coupled with the availability of other manuscripts providing dosing recommendations in this area [ 131415 ]. Comprehensive guidance for antibiotic dosing in obese adults. Effect of body weight on hemodynamic response in patients receiving fixed-dose vasopressin for septic shock. The effects of obesity on drug pharmacokinetics in humans. Summary: For vasopressors administered as continuous infusions, either a non-weight-based dosing regimen, or a weight-based dosing regimen using an ideal or adjusted body weight is suggested for initial doses in obese patients. High dose subcutaneous unfractionated heparin for prevention of venous thromboembolism in overweight neurocritical care patients.

READ TOO: Ppt On Obesity Diet Management

Efficacy and safety of high-dose thromboprophylaxis in morbidly obese inpatients. However, the International Society on Thrombosis and Haemostasis suggests that for patients who are morbidly obese who cannot use a vitamin K antagonist warfarin [Coumadin]physicians might consider checking anti—factor Xa peak and trough levels for apixaban [Eliquis], edoxaban [Savaysa], and rivaroxaban [Xarelto]. Bridgewater, N. Read the full article. To see the full article, log in or purchase access.

Although the sample size obtained was short of the initial goal, the dose obesity incidence of VTE was similar between the high-dose and low-dose groups 3 vs. Does body weight impact the efficacy of vasopressin therapy in the management of septic shock? Small volumes of distribution combined with rapid clearance values results in short half-lives for these agents typically necessitating their administration as continuous intravenous infusions. Anaesth Intensive Care in press. This paper is intended to help clinicians design initial dosing regimens in critically ill obese patients for medications commonly used for hemodynamic support or prophylaxis. Prevalence of obesity and severe obesity among adults: United States, —

Get Permissions. Navigate this Article. Low-molecular weight heparins, heparin, and fondaparinux are commonly used agents to prevent VTE, each of which has well established dosing regimens in patients with normal body mass index. Lawrence M.

Purchase Access: See My Options close. Am Fam Physician. Get immediate access, anytime, anywhere. Unfractionated heparin infusion therapy is often administered using a weight-based dosing strategy for the treatment of venous thromboembolism. We describe a kg man who was started on an intravenous infusion of heparin according to hospital protocol for suspected pulmonary embolism.

These studies have revealed PPI exposure correlates best with lean body weight dosing as opposed to actual body weight [ 4849 ]. If a weight-based method is chosen, seek consistency between using ideal or adjusted body weight across different vasopressor agents e. Conclusion High-level evidence describing dosing of supportive care medications in obesity is lacking. Reprints are not available from the authors.

The drug doses that are included, however, are often formulated for patients with normal body ddvt and do not account for the pharmacokinetic variability encountered with obesity. Lack of an effect of body mass on the hemodynamic response to arginine vasopressin during septic shock. View author publications. Bleeding was not associated with a high Xa-level.

Delzell Jr. Clinical Question Is high-dose heparin better than standard-dose heparin in reducing the incidence of venous thromboembolism VTE in obese inpatients? Send letters to afplet aafp. Best Value!

It was formulated more than 60 years ago using actuarial data based on the premise that for a ovesity height, there was an ideal weight [ 4 ]. Efficacy and safety of high-dose subcutaneous unfractionated heparin prophylaxis for the prevention of venous thromboembolism in obese hospitalized patients. Similar to the previous study, no difference in hemorrhage was noted. Barletta: Consultant for Wolters Kluwer. Optimized glucocorticoid therapy: teaching old drugs new tricks. Erstad BL.

Obesuty total of 1, adults were included in the analysis, including patients who received high-dose 7, units every 8 prophylaxis dose unfractionated heparin and patients who received low-dose 5, units every 8 hours unfractionated heparin. Full size image. Drug Intell Clin Pharm. Ethics declarations Ethics approval and consent to participate Not applicable. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rates of VTE within 30 days of hospitalization did not differ significantly between the high-dose and standard-dose groups 1.

Collections