• E M Hohner, R M Kruer, V T Gilmore, M Streiff, and H Gibbs.
• Department of Pharmacy, The Johns Hopkins Hospital, 600 N Wolfe St, Carnegie 180, Baltimore, MD 21287, USA. Electronic address: ehohner1@jhmi.edu.
• J Crit Care. 2015 Apr 1;30(2):395-9.

PurposeResearch evaluating unfractionated heparin (UFH) dosing in obese critically ill populations is limited. This study aimed to determine optimal weight-based and total therapeutic infusion rates of UFH in this population.MethodsThis retrospective cohort study compared adults on UFH infusions in intensive care units from May 2011 through October 2013 across 3 weight strata: 95 to 104 kg (control), 105 to 129 kg (high weight), and greater than or equal to 130 kg (higher weight). Primary outcomes included total and weight-based infusion rates for therapeutic anticoagulation.ResultsTo achieve therapeutic activated partial thromboplastin times, higher weight patients had higher mean infusion rates compared with control (2017 vs 1582 U/h; P = .002). Mean weight-based therapeutic infusion rate was lower in the higher weight group compared with control (13.1 vs 15.8 U kg(-1) h(-1); P = .008). Post hoc analyses indicated mean weight-based infusion rate to achieve therapeutic anticoagulation was 15 U kg(-1) h(-1) in patients less than 165 kg and 13 U kg(-1) h(-1) in patients greater than 165 kg.ConclusionsPatients greater than or equal to 130 kg have lower weight-based heparin requirements compared with patients 95 to 104 kg. This difference appears to be driven by patients greater than 165 kg. Patients greater than 165 kg have lower weight-based heparin requirements, whereas patients from 105 to 164 kg have weight-based requirements similar to a normal-weight patient population. Initiating heparin at appropriate weight-based doses for obese patients may optimize anticoagulation.Copyright © 2014 Elsevier Inc. All rights reserved.

32 keywords...

hide…