Obesity

Unfractionated heparin dosing in obese patients airway – Prevention of thrombotic risk in hospitalized patients with COVID-19 and hemostasis monitoring

Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Ann Pharmacother 45 7—8 —

Enoxaparin appears to be less susceptible to protamine sulfate reversal than dalteparin because its structure has less sulfonation [ 95 ]. The primary outcome assessed the rate of nosocomial VTE in obese patients treated with high-dose heparin 7, units subcutaneously q 8 h versus conventional-dose heparin 5, units subcutaneously q 8 h. We suggest that in limited populations, including patients with severe renal failure, trough anti - Xa levels may have a role in evaluating LMWH accumulation and the need to prolong the dosing interval. Rivaroxaban for the prevention of venous thromboembolism after hip or knee arthroplasty-pooled analysis of four studies. Guidance for the practical management of the heparin anticoagulants in the treatment of venous thromboembolism.

  • When a weight based heparin dosing strategy is selected, we suggest total body weight for calculating dose.

  • New York, NY; New York, NY; 2.

  • Table 1 Guidance questions to be considered Full size table. Intensive Crit Care Nurs.

  • Kandrotas RJ.

  • Titusville, NJ. Full size image.

PURPOSE/OBJECTIVES

About this article. Chest e24S—e43S. Ethics declarations Conflicts of interest The authors declare that they have no conflicts of interest.

Prospective study of BMI and the airwzy of pulmonary embolism in women. Clin Pharmacol Ther. We suggest that in all patients, including underweight and obese, LMWH dosing should be based on total unfractionated heparin dosing in obese patients airway weight. Guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Heparin has been a component of the initial treatment of venous thromboembolism VTE for decades. Patients weighing less than 50 kg should receive 5 mg SC once daily. In the uncommon situations in which anti-Xa activity is monitored, it should be determined using a chromogenic method and a calibration curve based on the LMWH used.

When comparing these rates to obese patients published literature using conventional-dose parients, thrombosis and bleeding rates were similar to this higher heparin dose. Ten false beliefs about cortisol in critically ill patients. Footnotes Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. J Thromb Thrombolysis — LessireJ. 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. The case for rabeprazole.

MeSH terms

Abstract Objective: To determine whether pediatric patients with obesity receiving weight-based dosages of unfractionated heparin UFH exhibit an enhanced response when dosed by actual body weight compared with nonobese patients as assessed primarily by the frequency of supratherapeutic anticoagulation. Arch Pathol Lab Med. View author publications. Abstract There is limited guidance on intravenous dosing of unfractionated heparin in obese patients.

All of the commonly used vasopressors are hydrophilic as indicated by negative log P values, so distribution is typically limited at most to the dpsing fluid compartment. Dosing is generally based on total body weight and renal function, evaluated using the Cockcroft-Gault method, further influences dosing requirement [ 59 ]. Venous thromboembolism prophylaxis in the medical patient: Controversies and perspectives. Although there were statistically fewer acute strokes in the high-dose group, this cannot necessarily be attributed to the higher dose of heparin because data were not collected on whether the finding of acute stroke was present on admission or nosocomial-acquired. Additionally, a secondary outcome assessed safety by quantifying bleeding events in both groups.

There is an inverse relationship between CrCl and anti-Xa levels, with accumulation of anti-Xa activity at the end of the dosing interval as airwy function declines [ 127172 ]. Antithrombin supplementation, which can increase the risk of bleeding in ICU patients [ 3132 ], is not recommended [ 33 ], as well as argatroban, which should be reserved only for patients with HIT [ 3034 ]. Risk of venous thromboembolism and efficacy of thromboprophylaxis in hospitalized obese medical patients and in obese patients undergoing bariatric surgery. Because of the tremendous variability observed, an individualized dosing approach is preferred [ 7 ]. However, these antibodies are often non-pathogenic in severe infections, and their persistence should therefore be checked after COVID recovery. Louis College of Pharmacy, St.

Publication types

The patient developed bloody pulmonary secretions with a therapeutic aPTTnecessitating the discontinuation of the heparin infusion. Objective To determine if current practices for unfractionated heparin dosing leads to inadequate anticoagulation in obese patients. Download citation.

The most appropriate dosing strategy for therapeutic UFH in this patient population is not clearly defined. You can also search for this author in PubMed Google Scholar. Nicholas Matigian Queensland Cyber Infrastructure Foundation Ltd for his help in statistical analysis, Neil Cottrell University of Queensland for his help in initial manuscript revisions. J Crit Care 30 2 — Intravenous unfractionated heparin dosing in obese patients using anti-Xa levels.

Ann Pharmacother 45 7—8 — Delayed efficient anticoagulation with heparin in patients with a weight of kg and more treated for acute coronary syndrome. Issue Date : April Australian Bureau of Statistics. Subscription will auto renew annually. Ann Pharmacother — J Crit Care.

Garrigue HuetA. Large VTE trials evaluating patient outcomes with heparin anti-Xa level monitoring are not available. Apixaban is the patiwnts recent agent to be approved for prevention of stroke and systemic embolism in nonvalvular AF. Unfractionated heparin dosing in obese patients airway MN, Hirsh J, Gent M et al A randomized trial comparing activated thromboplastin time with heparin assay in patients with acute venous thromboembolism requiring large daily doses of heparin. When a weight based heparin dosing strategy is selected, we suggest total body weight for calculating dose. These values are similar to those in the overall study. Importantly, there are no data to suggest that making dosing adjustments based on peak levels is correlated with improved safety or efficacy.

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Anticoagulating obese patients in the modern era. ABN Catalouge no. Download citation. Chest e24S—e43S. Article Google Scholar

  • In the most recent prospective trials evaluating SUP, weight is not reported, making the impact of obesity on outcomes difficult to determine [ 38 — 40 ].

  • PubMed Article Google Scholar. Thromb Haemost.

  • BonhommeA.

  • Vasopressors All of the commonly used vasopressors are hydrophilic as indicated by negative log P values, so distribution is typically limited at most to the extracellular fluid compartment.

  • A randomized controlled trial.

There is an inverse relationship between CrCl and anti-Xa levels, with accumulation of anti-Xa activity fosing the end of the dosing interval as renal function declines [ 127172 ]. Adjusted body weight kg [ 75 ]. Clin Pharmacol Ther. Trough anti-Xa concentrations may be helpful to evaluate the safety of LMWH dosing in special patient populations including patients with severe renal impairment although usefulness undetermined in patients on RRT and extremely low body weight [ 1259 ].

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Case number gentamicin therapy. Circulating HIT antibodies may remain unfractionaated for a median of 50—85 days depending on assay performed and re-exposure can lead to a large decrease in platelet count within 24 h. External link. Guidance Heparin for the treatment of acute VTE 1 How should heparin be initiated, including baseline laboratory tests and dosing? While it fully reverses the anti-IIa fraction of LMWH, it only partially reverses the anti-Xa component of LMWH due to the reduced sulfate charge in the ultra-low molecular weight heparin fragments present. What weight should be used to calculate dosing, and should obese and low body weight patients be treated differently?

Risk factors for venous thromboembolism. PTT confounding can be caused by disseminated intravascular coagulation, hepatic failure, VKA use obese patients lupus dosng. The incidence of VTE recurrence and major bleeding was low in the studies and the event rates between the studies that used a risk stratification model versus clinical judgment were similar. Background : Obese patients experience a higher risk of venous thromboembolism VTE than their nonobese counterparts, which may warrant a more aggressive approach to thromboprophylaxis in this population. Buller HR et al Fondaparinux or enoxaparin for the initial treatment of symptomatic deep vein thrombosis. Intensive Care Med.

Introduction

Published : 19 June Thomb Res — 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.

Therapeutic monitoring values were defined for activated partial thromboplastin time aPTT level seconds and anti-activated factor X Xa level 0. Anticoagulating obese patients in the modern era. Substances Anticoagulants Heparin. Int J Clin Pharm 42, — Publication types Case Reports Review. Ann Pharmacother 45 7—8 — Abstract There is limited guidance on intravenous dosing of unfractionated heparin in obese patients.

Rent this article via DeepDyve. Unfractionated heparin dosing in obese patients airway Anticoagulants Heparin. Shin S, Harthan EF Safety and efficacy of the use of institutional unfractionated heparin protocols for therapeutic anticoagulation in obese patients: a retrospective chart review. Unfractionated heparin infusion therapy is often administered using a weight-based dosing strategy for the treatment of venous thromboembolism. Am J Health- Syst Pharm — Abstract Background The effect of obesity on the pharmacokinetics and pharmacodynamics of unfractionated heparin is not clearly understood, therefore to reduce the risk of bleeding, maximal dose capped nomograms are often used.

In a retrospective review, the majority of anti-Xa levels were drawn inappropriately, limiting their utility for interpretation [ 68 ]. Inherent to this type of study design, some patients may not have been included in the study secondary to coding errors. GodierY. Guidance Statement We suggest patients be dosed based on total body weight. Lancet — Patients with symptomatic PE, obesity and malignancy all had higher rates of recurrent VTE when treated with 1.

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Mayo Clin Proc. Our results highlight recognized discrepancies between aPTT and anti-Xa monitoring assays. Acknowledgements Nicholas Matigian Queensland Cyber Infrastructure Foundation Ltd for his help in statistical analysis, Neil Cottrell University of Queensland for his help in initial manuscript revisions.

Circulation — Article Google Scholar 5. Delayed efficient anticoagulation with heparin in patients with a weight of kg and more treated for acute coronary syndrome. Correspondence to Christopher George. About this article.

Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Abstract Unfractionated heparin infusion therapy is often administered using a weight-based dosing strategy for the treatment of venous thromboembolism. The patient developed bloody pulmonary secretions with a therapeutic patienntsnecessitating the discontinuation of the heparin infusion. Safety and efficacy of the use of institutional unfractionated heparin protocols for therapeutic anticoagulation in obese patients: a retrospective chart review. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the Helsinki declaration and its later amendments or comparable ethical standards. This is a preview of subscription content, access via your institution. Nicholas Matigian Queensland Cyber Infrastructure Foundation Ltd for his help in statistical analysis, Neil Cottrell University of Queensland for his help in initial manuscript revisions.

Data on file. All bleeding events were minor. Chest — Article Google Scholar Ethics approval and consent to participate Not applicable. Background : Obese patients experience a higher risk of venous thromboembolism VTE than their nonobese counterparts, which may warrant a more aggressive approach to thromboprophylaxis in this population.

In a single center study, Cruickshank et al. Patients who presented with signs and symptoms of acute VTE on admission who were hospitalized within the previous 30 days and received heparin thromboprophylaxis during that admission were considered to have a nosocomial VTE. Am J Health Syst Pharm. PubMed Article Google Scholar. Medications used for supportive care or prophylaxis constitute a significant portion of drug utilization in the intensive care unit. MotteF.

In this study, the median BMI and weight was No significant difference was noted in the composite end point of major VTE; however, the comparator dose of enoxaparin may be inappropriate for obese patients. 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. The incidence of VTE was 9. Critical Care volume 24Article number: Cite this article. Effect of body weight on hemodynamic response in patients receiving fixed-dose vasopressin for septic shock. Nephron —

Background

Comparison of heparin dosing based on actual body weight in non-obese, obese and morbidly obese critically ill patients. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article. 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. Eikelboom JW, Hirsh J. Monitoring unfractionated heparin with the aPTT: time for a fresh look.

References 1. Relationship of activated partial thromboplastin time to coronary events and bleeding in obesee with acute coronary syndromes who receive heparin. Accepted : 20 February ABN Catalouge no. In the last several decades, the prevalence of obesity in the United States has increased significantly. Rights and permissions Reprints and Permissions.

Arch Intern Med 22 — Anticoagulant dosing in obesity should be individualized and drug-specific. Results of the College of American Pathologists proficiency testing. However, no study has formally documented an increased thrombotic risk in COVID compared to other severe infections, nor demonstrated that this risk was associated with a poor prognosis.

Heparin has been a component of the initial treatment of venous thromboembolism VTE for decades. Dose adjustment algorithms can be weight based e. Funding None. Antithrombotic prophylaxis is not required in case of low risk, but is necessary in all hospitalized and immobile patients, as for any severe acute infection [ 1314 ], with preference given to heparins.

Journal List Crit Care v. Finally, an elevated pre-treatment prothrombin time PT or activated partial thromboplastin time aPTT may detect the presence of an underlying coagulation defect. J Clin Pharm Ther.

Br J Clin Pharmacol. Additionally, corticosteroids easily pass through cell membranes to bind to cytosolic glucocorticoid receptors that are present in almost all body cells, so the relationship between pharmacokinetic and pharmacodynamics effects is complex [ 35 ]. Cuker A Unfractionated heparin for the treatment of venous thromboembolism: best practices and areas of uncertainty. J Thomb Haemost.

Clin Pharmacokinet 41 Suppl. Lean body weight appears to be the best representation of fat-free mass [ 5 ]. InBasu et al. VTE incidence and risk factors in patients with severe sepsis and septic shock. More recently, the impact of obesity, often associated with other comorbidities, has been highlighted in severe forms of COVID [ 7 ]. Smythe, M.

References 1. Subscription will auto renew annually. Monitoring unfractionated heparin with the aPTT: time for a fresh look.

The effects of obesity on drug pharmacokinetics in humans. Publisher's Note. All of these issues complicate the choice of heparln appropriate size descriptor when considering weight-based dosing regimens. Guidance Statement We suggest that in all patients, including underweight and obese, LMWH dosing should be based on total body weight. Dosing of unfractionated heparin in obese patients with venous thromboembolism.

Author information Copyright and License information Disclaimer. Efficacy and safety of high-dose thromboprophylaxis in morbidly obese inpatients. Crowther MA, Warkentin TE Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Subsequent studies from McMaster University demonstrated that this range was equivalent to a heparin anti-Xa level of approximately 0.

J Pharm Pract 23 3 — Heparin pharmacokinetics and pharmacodynamics. Download references.

Mol Cell Endocrinol. Evaluating the impact of obesity on safety and efficacy of weight-based norepinephrine dosing in septic shock: a single-center, retrospective study. Intensive Crit Care Nurs. A third trial randomized hospitalized medical patients to receive enoxaparin 40 mg daily, 0.

  • 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.

  • In: national health survey: first results, — Cite this article Ebied, A.

  • RoyS.

  • Ann Intern Med — Nephron —

Mayo Clin Proc. There was no difference in mean initial post-UFH aPTT between the 2 dosjng, but the mean initial anti-Xa level was higher in the obese group 0. Ann Pharmacother — Abstract There is limited guidance on intravenous dosing of unfractionated heparin in obese patients. Reprints and Permissions. Unfractionated heparin dosing for therapeutic anticoagulation in critically ill obese adults.

Current dosing recommendations do not specify which weight should be used. Results showed a decrease airsay VTE utilizing 40 mg twice daily without an increase in major bleeding. Competing interests Brian L. No significant difference was noted in the composite end point of major VTE; however, the comparator dose of enoxaparin may be inappropriate for obese patients. Warfarin Warfarin has been the only oral anticoagulant on the market in the United States for over 50 years. Oral rivaroxaban for symptomatic venous thromboembolism. In patients receiving some outpatient therapy, the rate of recurrent VTE was similar between the fondaparinux and enoxaparin groups 2.

Evaluation of heparin dosing based on adjusted body weight in obese patients. Google Scholar Substances Anticoagulants Heparin. Arch Pathol Lab Med.

  • The therapeutic range should be re-established with each change of reagent manufacturer, lot or coagulation instrument. Devine BJ.

  • Hirsh J, Raschke R. Arch Pathol Lab Med.

  • Ideal body weight does not account for differences in body composition or the increases in absolute lean mass that typically accompany obesity.

  • Results: The study included 50 children.

Also, minor bleeding events may not have been coded with an ICD-9 code if bleeding severity was considered to be low. Oatients of enoxaparin among obese and renal impairment patients. Increased time to a therapeutic INR was also noted between normal-weight 6 daysobese 8 daysand morbidly obese patients 10 days. In recognition of the variable sensitivity of different aPTT reagents to heparin, the use of an empiric fixed interval or fixed aPTT ratio for heparin monitoring is no longer recommended for treatment of VTE in national guidelines.

Immediate online access to all issues from Unfrractionated to Alex M. Conclusion: Compared with children without obesity, those with obesity who received actual body weight-based continuous UFH infusions did not exhibit a higher frequency of supratherapeutic anticoagulation, but did require lower dosages to achieve comparable anticoagulation. Accepted : 20 February Antithrombotic therapy for venous thromboembolic disease. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

COVID is a disease with high thrombotic risk, and heparin therapy with doses of LMWH or Obeae adjusted to the level of risk are required in all hospitalized patients, especially in obese and critically ill patients. Hosp Pharm. Le GalT. There are no recent trials evaluating unmonitored continuous infusion heparin therapy or different levels of heparin anticoagulation. MorangeS.

  • J Thrmob Haemost —

  • Intravenous unfractionated heparin dosing in obese patients using anti-Xa levels.

  • Br J Haematol. For weight-based dosing of methylprednisolone for patients with ARDS, the use of an ideal or adjusted body weight is suggested for weight-based dosing in obese patients, particularly in patients with more severe forms of obesity e.

  • Rabeprazole is metabolized by a non-enzymatic process.

Circulation — Queensland Issue Date : February Conclusion: Compared with children without obesity, those with obesity who received actual body weight-based continuous UFH infusions did not exhibit a higher frequency of supratherapeutic anticoagulation, but did require lower dosages to achieve comparable anticoagulation.

  • Susen Hematology, Cremona, Italy S.

  • J Thromb Thrombolysis 43 4 — Alex M.

  • The clinical trials evaluating LMWH did not use anti-Xa levels to guide dosing and anti-Xa levels have not been evaluated in large studies. In addition, mortality was lower in patients whose D-dimer levels were above this threshold, when treated with heparin [ 25 ].

  • Rights and permissions Reprints and Permissions.

  • While PE has historically been treated on an inpatient basis, a systematic review and meta-analysis of 11 studies, including patients, showed that low risk patients with PE can safety be treated as outpatients [ 87 ]. Google Scholar

  • Prospective study of BMI and the risk of pulmonary embolism in women. Coagulopathy and antiphospholipid antibodies in patients with Covid

Defining adult overweight and obesity April Unfractionated heparin infusion therapy is pagients administered using a weight-based dosing strategy for the treatment of venous thromboembolism. Pharmacotherapeutic aspects of unfractionated and low molecular weight heparins. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article. Kandrotas RJ.

Ethics declarations Conflicts of interest The authors declare that they have no conflicts of interest. Shin S, Harthan EF. Results: The mean infusion rate required to obtain a first therapeutic aPTT was Informed consent Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Despite its long history, various aspects of the practical use of unfractionated heparin Obese patientswhether delivered intravenously IV or subcutaneously SCcontinue to challenge clinicians. However in practice, when evaluation of thrombosis is not feasible, such as in critically ill ventilated patients, a probabilistic antithrombotic intensification should be considered when there is a high thrombotic risk. A proximal vein compression ultrasonography with Doppler of the common femoral and popliteal veins is proposed in the event of any unexplained clinical worsening, or in the case of a sudden increase in D-dimer levels. Table 1 Guidance questions to be considered Full size table.

  • Although therapy was unmonitored, on day 3 an aPTT was drawn and subsequently analyzed by a central laboratory at study conclusion. Knowledge of the most appropriate weight-metric for each medication is essential to optimize outcomes with drug therapy in the critically ill obese patient.

  • The patient developed bloody pulmonary secretions with a therapeutic aPTTnecessitating the discontinuation of the heparin infusion. Intravenous unfractionated heparin dosing in obese patients using anti-Xa levels.

  • Further, we suggest that once daily dalteparin can be used for the treatment of both cancer - and non - cancer - associated VTE. A comprehensive, online database was consulted for drug physicochemical properties e.

  • Anticoagulant dosing in obesity should be individualized and drug-specific.

  • Anticoagulant dosing in obesity should be individualized and drug-specific. Parenteral anticoagulants: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

  • Antifactor Xa levels versus activated partial thromboplastin time for monitoring unfractionated heparin.

J Pharm Pract 23 3 — Australian Prescriber. Circulation — Issue Date : April Mayo Clin Proc. Doses and times to therapeutic activated partial thromboplastin time aPTTbleeding rates, and mortality were assessed.

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As a result, we did not address the management of a consumptive coagulopathy, which can occur unfractionayed severe patients, nor certain situations such as ambulatory patients, pregnancy, or patients with underlying diseases e. VincentelliP. Giapreza angiotensin II [package insert]. Major bleeding was also similar between the groups 1. J Vasc Surg — Limiting dalteparin to the treatment of cancer-associated VTE is not necessary. We suggest that heparin dosing be guided by a dose adjustment nomogram, and that a weight based heparin dose adjustment algorithm may offer benefit over a fixed adjustment algorithm for the obese patient.

Abstract Background: Most literature available for unfractionated heparin UFH supports the use of actual body weight for dosing all patients, yet a small proportion of the patients in these studies were morbidly obese. Subscription will auto renew annually. J Thromb Thrombolysis 43 4 — Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

  • Article Google Scholar. Louis; and Abigail Yancey is associate professor of pharmacy practice, department of pharmacy practice, St.

  • Int J Clin Pharm 42, —

  • The average BMI in each of the groups was Heparin infusion rates resulting in therapeutic anticoagulation have ranged from 5 to

  • Chest 6 Suppl S—S.

  • J Crit Care 30 2 —

Medications used for supportive care or prophylaxis constitute a significant portion of drug utilization in the intensive care unit. Chest 3 Suppl S—S. Guidance Statement Parenteral anticoagulation with fondaparinux should be overlapped with warfarin for at least 5 days and until a single INR is 2. We suggest patients be dosed based on total body weight. Thromb Res. In recognition of the variable sensitivity of different aPTT reagents to heparin, the use of an empiric fixed interval or fixed aPTT ratio for heparin monitoring is no longer recommended for treatment of VTE in national guidelines.

Green B, Duffull SB. Abstract Background: Most literature available for unfractionated heparin UFH supports the use of actual body weight for dosing all patients, yet a small proportion of the patients in these studies were morbidly obese. Article Google Scholar. Ebied, A. Kandrotas RJ. Abstract Background The effect of obesity on the pharmacokinetics and pharmacodynamics of unfractionated heparin is not clearly understood, therefore to reduce the risk of bleeding, maximal dose capped nomograms are often used. Search SpringerLink Search.

Download references. Published : 05 September Rent this article via DeepDyve.

J Thromb Thrombolysis. Abstract Medications used unfractionaed supportive care or prophylaxis constitute a significant portion of drug utilization in the intensive care unit. Protocols based on total body weight increase the risk of a supra-therapeutic aPTT; however no increase in bleeding has been reported [ 16 ]. Morbid obesity rates continue to rise rapidly in the United States. This equivalency between assay systems was promoted by national guidelines despite data challenges to its validity [ 1224 ].

Blood Coag Fibrinol. Study design: This single-institution retrospective case-matched study included children with and without obesity, matched on a basis, who received a weight-based continuous infusion of UFH. The purpose of this study was to determine the efficacy and safety of a standard unfractionated heparin UFH protocol in obese patients based on total body weight TBW or adjusted body weight ABW to reach two consecutive therapeutic anti-Xa levels. Appendix 1: Queensland health unfractionated heparin nomogram [12] Appendix 1: Queensland health unfractionated heparin nomogram [ 12 ]. Relationship of activated partial thromboplastin time to coronary events and bleeding in patients with acute coronary syndromes who receive heparin. Hirsh J, Raschke R.

Measuring anti-factor Xa activity to monitor low-molecular-weight heparin in obesity: a critical review. Major bleeding rates were also not different between patients receiving fondaparinux and a heparin in non-obese 1. Chest 3 Suppl S—S Achievement of anticoagulation by using a weight-based heparin dosing protocol for obese and nonobese patients.

Mayo Clin Proc. Immediate online access to all issues from However, compared with patients without obesity, those with obesity received a lower mean starting dose Ebied View author publications. Heparin and low-molecular-weight heparin: the seventh ACCP conference on antithrombotic and thrombolytic therapy. You can also search for this author in PubMed Google Scholar. The patient later died after developing pulseless electrical activity.

Google Scholar. These values are similar to those in the overall study. You can also search for this author in PubMed Google Scholar. Body weight or BMI effects on Pradaxa. Lobo B et al Fondaparinux for the treatment of patients with acute heparin-induced thrombocytopenia. J Thrmob Haemost —

Heparin and low-molecular-weight heparin: the seventh ACCP conference on antithrombotic and thrombolytic therapy. The average time to two consecutive therapeutic UFH levels was Circulation — New York, NY; Results: The mean infusion rate required to obtain a first therapeutic aPTT was Acknowledgements Nicholas Matigian Queensland Cyber Infrastructure Foundation Ltd for his help in statistical analysis, Neil Cottrell University of Queensland for his help in initial manuscript revisions.

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