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Assessing Safety and Efficacy of Lean Body Weight-Based intravenous Heparin Dosing in Obese and Morbidly Obese Patients FREE TO VIEW

Rachel Park, PharmD; Scott Chelemer, MD; Jason Varghese, PharmD; Cheryl Leddy, MD; Lewis Rose, MD
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Nazareth Hospital - Mercy Health System/Trinity Health, Philadelphia, PA

Chest. 2015;148(4_MeetingAbstracts):1010A. doi:10.1378/chest.2254192
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SESSION TITLE: Venous Thromboembolism Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: In obese/morbidly obese (O/MO) patients, dosing intravenous (IV) heparin can be problematic. Very large bolus and infusion doses are needed if actual body weight (ABW) or adjusted body weight-based dosing is used. Therefore, empiric dosing is frequently utilized, and achieving therapeutic aPTT in a timely fashion is often difficult. We assessed whether dosing heparin using lean body weight (LBW) would be safe and effective in achieving rapid therapeutic anticoagulation with IV heparin

METHODS: We enrolled 115 patients with body mass index of 30 or greater requiring IV heparin for venous thromboembolic disease, acute coronary syndrome, or atrial fibrillation from May 2011 to March 2014. LBW was used to calculate initial bolus dose and infusion rate, and aPTT’s were obtained at baseline and every 6 hours for 24 hours or until aPTT was therapeutic, whichever came first. Primary outcome was the percentage of patients achieving therapeutic aPTT within 24 hours. We also assessed the time needed to reach therapeutic aPTT, total amount of heparin used for initial bolus and initial infusion, number of aPTT tests, percentage of patients who were therapeutic at each 6 hour interval, and bleeding complications. Historical controls who had IV heparin dosed conventionally were used for comparison.

RESULTS: LBW-based IV heparin dosing achieved therapeutic aPTT by 24 hours in 66.1% of patients, compared to 43.2% in historical controls (p = <0.001), and over 50% of patients were therapeutic by 18 hours. Fewer patients in the LBW group than the controls had a supratherapeutic aPTT value within 24 hours (7.8% versus 65.2%, p = <0.0001). The LBW-based bolus and initial infusion IV heparin doses were significantly lower than ABW. No bleeding events or complications occurred in the study patients.

CONCLUSIONS: LBW-based IV heparin dosing appears to be an effective method of dosing IV heparin in O/MO patients. Randomized clinical trials are needed.

CLINICAL IMPLICATIONS: IV heparin dosing based on lean body weight is safe and effective in achieving rapid therapeutic anticoagulation in O/MO patients.

DISCLOSURE: The following authors have nothing to disclose: Rachel Park, Scott Chelemer, Jason Varghese, Cheryl Leddy, Lewis Rose

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