Evaluation of an Unfractionated Heparin Pharmacy Dosing Protocol for the Treatment of Venous Thromboembolism in Nonobese, Obese, and Severely Obese Patients

The Annals of Pharmacotherapy
Lindsey M HoschChad A Knoderer

Abstract

Despite large interpatient variability in dose response, heparin is utilized for treatment of venous thromboembolism (VTE). Current data on the optimal heparin dosing in obese patients are conflicting. The objective was to evaluate the time and dose required to achieve a therapeutic activated partial thromboplastin time (aPTT) in nonobese, obese, and severely obese patients using a pharmacist-directed heparin dosing protocol. This was a retrospective cohort study in a single-center community hospital inpatient setting. Adult patients receiving heparin for VTE treatment from July 1, 2013, to July 31, 2015, were evaluated. Patients were categorized into 3 groups: nonobese (BMI < 30 kg/m2), obese (BMI = 30-39.9 kg/m2), and severely obese (BMI ≥ 40 kg/m2). Data on height, weight, initial bolus dose, initial infusion rate, time to therapeutic aPTT, and therapeutic infusion rate were collected. Dosing body weight (DBW) was utilized for patients 20% over their ideal body weight (IBW). The primary outcome was time to therapeutic aPTT. Analysis included 298 patients. Median times to therapeutic aPTT (hours:minutes) in the nonobese, obese, and severely obese were 15:00 (interquartile range [IQR] = 8:05-23:21), 15:40 (IQR = 9:22-25:10), a...Continue Reading

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Citations

Sep 6, 2019·Journal of Thrombosis and Thrombolysis·Alex M EbiedYiqing Chen
Mar 7, 2020·International Journal of Clinical Pharmacy·Christopher GeorgeKarl Winckel

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Methods Mentioned

BETA
blood draws

Software Mentioned

Statistical Package for Social Sciences
RxConsult

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