Adjusted Versus Total Body Weight Dosing for Intravenous Heparin Infusions and Target Attainment in Obese Patients.

IF 0.7 Q4 PHARMACOLOGY & PHARMACY
Kristine Nguyen, Brian Murray, Stacy Campbell-Bright, Lee Ann Jones, Julia Fabricio Donahue, Quynh Nguyen, Theresa M Kline
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引用次数: 0

Abstract

Background: Intravenous unfractionated heparin is commonly used to treat venous thromboembolism; however, dosing in obese patients is challenging due to unpredictable pharmacokinetics and conflicting guidance. Methods: This single center, retrospective cohort study was conducted to evaluate the achievement of therapeutic heparin correlation values (HCV), a standardized version of the activated partial thromboplastin time (aPTT), with heparin infusions dosed utilizing total body weight (TBW) versus adjusted body weight (ABW) in obese patients. The primary outcome was to determine the percentage of initial HCV within the therapeutic range after heparin initiation. Key secondary outcomes included incidence of supratherapeutic HCV at any time and major bleeding events. Results: A total of 477 patients were included, with 94.9% (n = 453) of patients in the TBW cohort (mean body mass index (BMI) 36.8 ± 7.4 kg/m2) and 5.1% (n = 24) in the ABW cohort (mean BMI 42.1 ± 9.3 kg/m2). Initial HCV was within the therapeutic range in 41.9% (n = 190) and 54.2% (n = 13) of patients in the TBW cohort and ABW cohort, respectively (P = .238). Supratherapeutic HCV during any point in therapy occurred in 64.7% (n = 293) of the TBW cohort and 41.7% (n = 10) of the ABW cohort (P = .022). Major bleeding occurred in 15.2% (n = 69) of patients in the TBW cohort and 12.5% (n = 3) in the ABW cohort (P = .716). Conclusions: In obese patients receiving a heparin infusion, dosing based on ABW compared to TBW did not result in a higher likelihood of achieving a therapeutic initial HCV, but the rate of supratherapeutic HCV was reduced.

肥胖患者静脉注射肝素的调整剂量与总体重剂量和目标实现。
背景:静脉不分离肝素常用于治疗静脉血栓栓塞;然而,由于不可预测的药代动力学和相互矛盾的指导,肥胖患者的给药具有挑战性。方法:本研究采用单中心、回顾性队列研究,评估肥胖患者肝素输注以总体重(TBW)和调整体重(ABW)为计量标准的活化部分凝血酶活时间(aPTT)的治疗性肝素相关值(HCV)的实现情况。主要结果是确定肝素治疗后治疗范围内初始HCV的百分比。关键的次要结局包括任何时间超治疗HCV的发生率和主要出血事件。结果:共纳入477例患者,其中TBW组(平均体重指数(BMI) 36.8±7.4 kg/m2)占94.9% (n = 453), ABW组(平均体重指数(BMI) 42.1±9.3 kg/m2)占5.1% (n = 24)。TBW组和ABW组中,分别有41.9% (n = 190)和54.2% (n = 13)的患者初始HCV在治疗范围内(P = 0.238)。在治疗的任何时间点,64.7% (n = 293)的TBW组和41.7% (n = 10)的ABW组(P = 0.022)出现超治疗性HCV。TBW组15.2% (n = 69)患者发生大出血,ABW组12.5% (n = 3)患者发生大出血(P = .716)。结论:在接受肝素输注的肥胖患者中,与TBW相比,基于ABW的剂量并没有导致更高的可能性获得治疗性初始HCV,但超治疗性HCV的发生率降低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Hospital Pharmacy
Hospital Pharmacy PHARMACOLOGY & PHARMACY-
CiteScore
1.70
自引率
0.00%
发文量
63
期刊介绍: Hospital Pharmacy is a monthly peer-reviewed journal that is read by pharmacists and other providers practicing in the inpatient and outpatient setting within hospitals, long-term care facilities, home care, and other health-system settings The Hospital Pharmacy Assistant Editor, Michael R. Cohen, RPh, MS, DSc, FASHP, is author of a Medication Error Report Analysis and founder of The Institute for Safe Medication Practices (ISMP), a nonprofit organization that provides education about adverse drug events and their prevention.
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