TITLE

Effect of Body Mass Index on Bleeding Frequency and Activated Partial Thromboplastin Time in Weight-Based Dosing of Unfractionated Heparin: A Retrospective Cohort Study

AUTHOR(S)
BAUER, SETH R.; OU, NARITH N.; DREESMAN, BENJAMIN J.; ARMON, JEFFREY J.; ANDERSON, JAN A.; CHA, STEPHEN S.; OYEN, LANCE J.
PUB. DATE
December 2009
SOURCE
Mayo Clinic Proceedings;Dec2009, Vol. 84 Issue 12, p1073
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: To assess bleeding and activated partial thromboplastin time (APTT) In relation to body mass Index (BMI) in patients prescribed weight-based dosing of intravenous unfractionated heparin (UFH) for cardiac indications without a maximum (dose-capped) Initial bolus or capped Initial infusion rate. PATIENTS AND METHODS: Consecutive patients admitted to an academic medical center from February 1, 2002, through November 31, 2003, who were treated with a UFH nomogram consisting of a 60-U/kg intravenous bolus plus an initial continuous intravenous infusion of 12 u/kg hourly and titrated to a goal APTT range corresponding to thromboplastin-adjusted target heparin levels of 0.3 to 0.7 u/mL by anti-Xa assay were evaluated for this retrospective cohort study. Patients were excluded if they concomitantly received a fibrinolytic, glycoprotein lib/lila inhibitor, or any other antithrombotic agent (except warfarin). Study patients were divided into quartiles by BMI. RESULTS: Of the 1054 patients Included in the study, 807(76.6%) had an initial bolus dose higher than 4000 u, and 477 (45.3%) had an initial Infusion rate higher than 1000 u/h. Despite a significant difference among BMI quartiles in proportion of supratherapeutic first APTT values (P<.001), no statistically significant difference was found in bleeding frequency (P=.26) or frequency of first APTT within the goal range (P=.27). Logistic regression analyses revealed that BMI was not a significant predictor of bleeding or first APTT within the goal range. CONCLUSION: We did not find any difference in the proportion of first APTT values in the goal range or an increased risk of bleeding In obese patients treated with UFH without a capped initial dose. Our data demonstrate the safe use of weight-based UFH without a capped Initial bolus dose or capped initial infusion rate in patients with medical cardiac conditions.
ACCESSION #
45895949

 

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