Identifying Optimal Initial Infusion Rates for Unfractionated Heparin in Morbidly Obese Patients

Abstract

Morbidly obese patients require smaller UFH infusion rates per kilogram actual body weight compared to patients with lower body mass indices. UFH dosing recommendations should be modified to reflect body mass index classification.

Delayed efficient anticoagulation with heparin in patients with a weight of 110 kg and more treated for acute coronary syndrome

“…Heparin's distribution volume by weight should therefore be proportionally lower in the obese patient. This was evidenced by lower heparin doses by weight necessary for adequate anticoagulation in previous studies (20)(21)(22). Although we believe that body composition in obese patients may influence heparin requirement, the difference in threshold infusion rate between total body weight categories was nonstatiscally significant in this study.…”

“…This may be explained by a time to therapeutic aPTT for nonobese patients of 30.0 6 77.0 hours, which is at odd with our results and previous studies (23)(24)(25)(26)(27) involving nonobese patients. This could be since, unlike the present study, most patients in the study from Riney et al (20) did not receive an initial bolus. Moreover, time to therapeutic aPTT for morbidly obese patients was lower than our results.…”

“…Available literature seems to support the use of total body weight with specified maximum initial bolus and infusion rates for obese patients (21,25,27,28). Maximum doses were suggested to avoid higher aPTTs than desired and an increased risk of bleeding as heparin requirements do not increase linearly with obese body weight (20,21). However, most of these previous studies (21,25,(27)(28)(29) included small numbers of obese patients weighing !110 kg.…”

Treatment of Suspected Pulmonary Embolism in a Super-Obese Individual

“…[1][2][3] In addition, clinical trials for the treatment of deep vein thrombosis or pulmonary embolism in obese individuals are scarce, with most trials limiting entry to persons weighing no more than 120 kg. 4 The case reported here involved use of unfractionated heparin (UFH) followed by warfarin in a super-obese individual presenting with presumed pulmonary embolism.…”

“…This decision is consistent with the trends of scholarly societies over the past 10 years or so, which have increasingly been moving away from print toward online-only journal subscriptions. 2 As CSHP members are aware, CJHP has been available in an online format, in addition to the print format, since 2009. It is notable that most academic libraries have been moving to an online-only environment for over a decade now.…”