Dosing of Unfractionated Heparin in Obese Patients with Venous Thromboembolism
Dosing of Unfractionated Heparin in Obese Patients with Venous Thromboembolism
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DOI：
10.1007/s11606-010-1551-2
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发表时间：
2011-05-01
影响因子：
5.7
通讯作者：
Brand, Donald A.
中科院分区：
文献类型：
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作者：
Hurewitz, Adam N.;Khan, Samar U.;Brand, Donald A.
积极的以体重为基础的给药指南有助于实现静脉血栓栓塞（VTE）患者的及时治疗抗凝。虽然患有静脉血栓栓塞的肥胖患者面临着更高的复发风险，但由于担心出血并发症，医生通常会拒绝开出两到三倍于通常剂量的处方剂量。目的：研究一家学术教学医院肥胖静脉血栓栓塞患者使用未分级肝素的情况，以记录这一高危患者人群中处方不足的程度和模式。三年，横断面连续的案例系列。静脉血栓栓塞的成年住院患者，体重指数为千分之一日元30 kg/m(2)，接受未分级肝素治疗。达到治疗性抗凝的时间（活化部分凝血活素时间bbb60秒）和推荐剂量与处方剂量之间的差距。29%的患者（84例）达到治疗性抗凝治疗的时间超过24小时，14%的患者超过48小时。在75名患者（89%）中，规定的丸剂剂量低于80单位/kg的推荐剂量，在64名患者（76%）中，初始连续输注剂量低于推荐剂量18单位/kg/h 100单位/h以上，有些病例低于1000单位/h以上。抗凝治疗时间与初始输注剂量有显著相关性（Spearman r = -0.27; p < 0.02）。每减少1单位/kg/h，在规定剂量范围内（6至22单位/kg/h）延迟约0.75小时至1.5小时。在接受未分割肝素治疗的肥胖患者中，有相当大比例的患者在达到充分抗凝治疗时延迟了bbbb24小时，并且根据目前的剂量指南，绝大多数患者接受了不充分的肝素丸或初始持续输注（或两者兼有）。
Aggressive weight-based dosing guidelines help achieve prompt therapeutic anticoagulation in patients with venous thromboembolism (VTE). While obese patients with VTE face an increased risk of recurrence, physicians typically resist prescribing doses two to three times the usual dose because of concern about bleeding complications.To examine the use of unfractionated heparin in obese patients with VTE at an academic teaching hospital in order to document the extent and pattern of underprescribing in this high-risk patient population.Three-year, cross-sectional consecutive case series.Adult inpatients with VTE and a body mass index a parts per thousand yen30 kg/m(2) who were treated with unfractionated heparin.Time to achievement of therapeutic anticoagulation (activated partial thromboplastin time > 60 s) and gap between recommended and prescribed heparin doses.Time to attainment of therapeutic anticoagulation exceeded 24 h in 29% of study patients (n = 84) and exceeded 48 h in 14% of patients. In 75 patients (89%), the prescribed bolus dose fell below the recommended dose of 80 units/kg, and in 64 patients (76%) the initial continuous infusion fell more than 100 units/h below-in some cases more than 1000 units/h below-the recommended dose of 18 units/kg/h. There was a significant correlation between time to therapeutic anticoagulation and initial infusion dose (Spearman r = -0.27; p < 0.02). Each decrease of 1 unit/kg/h translated to a delay ranging from about 0.75 h to 1.5 h over the range of prescribed doses (6 to 22 units/kg/h).A substantial proportion of obese patients treated with unfractionated heparin experienced a delay > 24 h in achieving adequate anticoagulation, and the vast majority received an inadequate heparin bolus or initial continuous infusion (or both) according to current dosing guidelines.