Optimal Heparin Dosing in the Obese and Morbidly Obese

Chad A. Knoderer; Emily Breedlove; Lindsey Hosch; Lauren Scono

Optimal Heparin Dosing in the Obese and Morbidly Obese

Chad A. Knoderer, Emily Breedlove, Lindsey Hosch, Lauren Scono

Butler University

Research output: Contribution to conference › Presentation

Abstract

   INTRODUCTION:  Despite large inter-patient variability in response at similar doses, heparin is frequently utilized for treatment of venous thromboembolism (VTE). Current data on the most optimal heparin dosing strategy for overweight/obese patients is conflicting.
   RESEARCH QUESTION OR HYPOTHESIS  : In patients receiving therapeutic heparin infusions, is there a difference in the time to activated partial prothrombin time (aPTT) goals in nonobese, obese, and morbidly obese patients?
   STUDY DESIGN:  This was a retrospective cohort study.
   METHODS:  Patients 18 years or older receiving heparin for VTE treatment from July 1, 2013 to July 31, 2015 were evaluated, and categorized into three groups based on body mass index (BMI): normal (BMI < 30 kg/m2), obese (BMI 30 - 39.9 kg/m2), and morbidly obese (BMI >= 40 kg/m2). Height, weight, initial bolus dose, initial infusion rate, time aPTT and therapeutic infusion rate were collected. Therapeutic aPTT was considered 57 to 96 sec. The primary outcome was time to therapeutic aPTT. Secondary outcomes were bleeding and recurrent thromboembolic events. Demographic and clinical characteristics, including primary and secondary outcomes, between groups were compared using Chi-square, analysis of variance, or Kruskall-Wallis for non-parametric data. p-values <0.05 were considered statistically significant.
   RESULTS:  A total of 121 non-obese, 110 obese, and 63 morbidly obese patients were included, with a mean (SD) age (years) of 66.6 (16.5), 66 (14.5), and 57 (15.6), respectively. Median (IQR) time to first therapeutic aPTT (hours:min) was 15:00 (8:04 - 23:21), 15:40 (9:22 - 25:09), and 15:22 (7:54 - 23:40; p=0.229). Bleeding events occurred in 14%, 11.8% and 7.9% of non obese, obese, and morbidly obese patients (p=0.478), respectively. No recurrent thromboembolic events were documented.
   CONCLUSION:  These findings suggest that obese and morbidly obese patients achieve a therapeutic aPTT within a similar timeframe as non-obese patients when a dosing body weight is utilized for heparin dosing.

Original language	American English
State	Published - Dec 2016
Event	2016 ACCP Annual Meeting - Duration: Dec 1 2016 → …

Conference

Conference	2016 ACCP Annual Meeting
Period	12/1/16 → …

Keywords

dosing
heparin
morbidly obese
obese

Disciplines

Medicine and Health Sciences
Medical Sciences
Pharmacy and Pharmaceutical Sciences
Other Pharmacy and Pharmaceutical Sciences

Cite this

@conference{4c78582243694551b50ebaa4e096559b,

title = "Optimal Heparin Dosing in the Obese and Morbidly Obese",

abstract = " INTRODUCTION: Despite large inter-patient variability in response at similar doses, heparin is frequently utilized for treatment of venous thromboembolism (VTE). Current data on the most optimal heparin dosing strategy for overweight/obese patients is conflicting. RESEARCH QUESTION OR HYPOTHESIS : In patients receiving therapeutic heparin infusions, is there a difference in the time to activated partial prothrombin time (aPTT) goals in nonobese, obese, and morbidly obese patients? STUDY DESIGN: This was a retrospective cohort study. METHODS: Patients 18 years or older receiving heparin for VTE treatment from July 1, 2013 to July 31, 2015 were evaluated, and categorized into three groups based on body mass index (BMI): normal (BMI < 30 kg/m2), obese (BMI 30 - 39.9 kg/m2), and morbidly obese (BMI >= 40 kg/m2). Height, weight, initial bolus dose, initial infusion rate, time aPTT and therapeutic infusion rate were collected. Therapeutic aPTT was considered 57 to 96 sec. The primary outcome was time to therapeutic aPTT. Secondary outcomes were bleeding and recurrent thromboembolic events. Demographic and clinical characteristics, including primary and secondary outcomes, between groups were compared using Chi-square, analysis of variance, or Kruskall-Wallis for non-parametric data. p-values <0.05 were considered statistically significant. RESULTS: A total of 121 non-obese, 110 obese, and 63 morbidly obese patients were included, with a mean (SD) age (years) of 66.6 (16.5), 66 (14.5), and 57 (15.6), respectively. Median (IQR) time to first therapeutic aPTT (hours:min) was 15:00 (8:04 - 23:21), 15:40 (9:22 - 25:09), and 15:22 (7:54 - 23:40; p=0.229). Bleeding events occurred in 14%, 11.8% and 7.9% of non obese, obese, and morbidly obese patients (p=0.478), respectively. No recurrent thromboembolic events were documented. CONCLUSION: These findings suggest that obese and morbidly obese patients achieve a therapeutic aPTT within a similar timeframe as non-obese patients when a dosing body weight is utilized for heparin dosing.",

keywords = "dosing, heparin, morbidly obese, obese",

author = "Knoderer, {Chad A.} and Emily Breedlove and Lindsey Hosch and Lauren Scono",

year = "2016",

month = dec,

language = "American English",

note = "2016 ACCP Annual Meeting ; Conference date: 01-12-2016",

}

TY - CONF

T1 - Optimal Heparin Dosing in the Obese and Morbidly Obese

AU - Knoderer, Chad A.

AU - Breedlove, Emily

AU - Hosch, Lindsey

AU - Scono, Lauren

PY - 2016/12

Y1 - 2016/12

N2 - INTRODUCTION: Despite large inter-patient variability in response at similar doses, heparin is frequently utilized for treatment of venous thromboembolism (VTE). Current data on the most optimal heparin dosing strategy for overweight/obese patients is conflicting. RESEARCH QUESTION OR HYPOTHESIS : In patients receiving therapeutic heparin infusions, is there a difference in the time to activated partial prothrombin time (aPTT) goals in nonobese, obese, and morbidly obese patients? STUDY DESIGN: This was a retrospective cohort study. METHODS: Patients 18 years or older receiving heparin for VTE treatment from July 1, 2013 to July 31, 2015 were evaluated, and categorized into three groups based on body mass index (BMI): normal (BMI < 30 kg/m2), obese (BMI 30 - 39.9 kg/m2), and morbidly obese (BMI >= 40 kg/m2). Height, weight, initial bolus dose, initial infusion rate, time aPTT and therapeutic infusion rate were collected. Therapeutic aPTT was considered 57 to 96 sec. The primary outcome was time to therapeutic aPTT. Secondary outcomes were bleeding and recurrent thromboembolic events. Demographic and clinical characteristics, including primary and secondary outcomes, between groups were compared using Chi-square, analysis of variance, or Kruskall-Wallis for non-parametric data. p-values <0.05 were considered statistically significant. RESULTS: A total of 121 non-obese, 110 obese, and 63 morbidly obese patients were included, with a mean (SD) age (years) of 66.6 (16.5), 66 (14.5), and 57 (15.6), respectively. Median (IQR) time to first therapeutic aPTT (hours:min) was 15:00 (8:04 - 23:21), 15:40 (9:22 - 25:09), and 15:22 (7:54 - 23:40; p=0.229). Bleeding events occurred in 14%, 11.8% and 7.9% of non obese, obese, and morbidly obese patients (p=0.478), respectively. No recurrent thromboembolic events were documented. CONCLUSION: These findings suggest that obese and morbidly obese patients achieve a therapeutic aPTT within a similar timeframe as non-obese patients when a dosing body weight is utilized for heparin dosing.

AB - INTRODUCTION: Despite large inter-patient variability in response at similar doses, heparin is frequently utilized for treatment of venous thromboembolism (VTE). Current data on the most optimal heparin dosing strategy for overweight/obese patients is conflicting. RESEARCH QUESTION OR HYPOTHESIS : In patients receiving therapeutic heparin infusions, is there a difference in the time to activated partial prothrombin time (aPTT) goals in nonobese, obese, and morbidly obese patients? STUDY DESIGN: This was a retrospective cohort study. METHODS: Patients 18 years or older receiving heparin for VTE treatment from July 1, 2013 to July 31, 2015 were evaluated, and categorized into three groups based on body mass index (BMI): normal (BMI < 30 kg/m2), obese (BMI 30 - 39.9 kg/m2), and morbidly obese (BMI >= 40 kg/m2). Height, weight, initial bolus dose, initial infusion rate, time aPTT and therapeutic infusion rate were collected. Therapeutic aPTT was considered 57 to 96 sec. The primary outcome was time to therapeutic aPTT. Secondary outcomes were bleeding and recurrent thromboembolic events. Demographic and clinical characteristics, including primary and secondary outcomes, between groups were compared using Chi-square, analysis of variance, or Kruskall-Wallis for non-parametric data. p-values <0.05 were considered statistically significant. RESULTS: A total of 121 non-obese, 110 obese, and 63 morbidly obese patients were included, with a mean (SD) age (years) of 66.6 (16.5), 66 (14.5), and 57 (15.6), respectively. Median (IQR) time to first therapeutic aPTT (hours:min) was 15:00 (8:04 - 23:21), 15:40 (9:22 - 25:09), and 15:22 (7:54 - 23:40; p=0.229). Bleeding events occurred in 14%, 11.8% and 7.9% of non obese, obese, and morbidly obese patients (p=0.478), respectively. No recurrent thromboembolic events were documented. CONCLUSION: These findings suggest that obese and morbidly obese patients achieve a therapeutic aPTT within a similar timeframe as non-obese patients when a dosing body weight is utilized for heparin dosing.

KW - dosing

KW - heparin

KW - morbidly obese

KW - obese

M3 - Presentation

T2 - 2016 ACCP Annual Meeting

Y2 - 1 December 2016

ER -